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Purpose of the study: to study the reasons for seeking outpatient medical care for patients in whom, after death, the code R-54 (old age) is indicated in the medical death certificate (MCD) as the initial cause of death (PPD).Materials and methods of research. Data from the electronic database of the Main Department of the Civil Registry Office of the Moscow Region (USR registry office system of the Moscow Region) and electronic medical records (EMC) from outpatient clinics of the Moscow Region for 2020–2021. In total, 1,269 cases were registered in the MSS with the code R-54 (old age) indicated in the MCD as a PPD, of which 987 (77.7 %) sought outpatient medical care. Data included gender, age, 4-digit ICD codes for all reasons for referrals.Results. The mean age of the deceased was 87.7 ± 4.7 years (minimum 76 years, maximum 103 years; 1.4 % under the age of 80; females 88.08 ± 4.7; males 86.59 ± 4.6 p < 0.001). In 4 of the deceased, IHD was indicated as other causes contributing to death (part II of the MCD). On average, there were 3.77 ± 3.98 (men 4.2 ± 3.6 and women 3.6 ± 3.3; p = 0.04) reasons for visiting, indicated by 4-digit ICD codes. IHD group codes were registered in 21 %; AG 38.5 %; codes of the group “cerebrovascular diseases” – 25.3 %; cancer – 6.8 %; 5.1 % diabetes mellitus; 9.8 % – COVID-19. Among those who registered one reason for contacting (25 % – 1 4-digit ICD-10 code), 70 % applied for diseases, the rest of the reasons for contacting belonged to the codes of groups R, S and Z.Conclusion. In the overwhelming majority of cases, the R-54 code in the MCD is used unreasonably. However, taking into account the position of the WHO set out in the ICD and data from other countries, it is necessary to clarify the criteria for the use of both this code and other vaguely defined terms and codes that are used in the MCD as PPD.

A significant number of studies on chronic heart failure (CHF) are published worldwide. However, the issue of uniform criteria and approaches to accounting for ambulatory care and mortality associated with this pathology in patient accounting systems has remained resolved, meaning the data and indicators obtained in different regions and countries are not comparable. The aim of the article is to substantiate the need for discussion in the Russian Society of Cardiology on the possibility, principles and methodology of uniform accounting of ambulatory care, hospitalizations and deaths associated with chronic heart failure in healthcare using the classifications of heart failure applied in clinical practice.

The aim. Analysis of data from medical certifi cates of death, in which the diagnosis of new coronavirus infection (COVID-19) is indicated as the primary cause of death or the contributing cause factor of death.Material and methods. The study was carried out on the basis of the electronic database of the Main Directorate of the Civil Registry Office of the Moscow Region, based on medical death certificates for 2020. All cases (13,356), in which the diagnosis of COVID-19 is indicated as the primary cause of death or the contributing cause factor of death, were selected. The analysis included deaths registered in the hospital (12,960). 3 groups were formed: group 1 — deaths from COVID 19, without concomitant pathology — 5620 (43.4%), group 2 — deaths from COVID-19 with concomitant pathology — 5706 (44%), and group 3, in which COVID-19 was indicated as the contributing cause factor of death — 1634 (12.6%).Results. In addition to COVID-19, 100% of deaths were caused by pneumonia. At the age group of up to 30 years, the number of deaths was 0.4%, among people of 31–50 years old — 6.6%, 51–70 years old — 36.9%, and over the age of 70 years old — 56.1%. In the group of those who died from COVID-19 (group 2), coronary heart disease (CHD) and/or arterial hypertension (AH), diabetes mellitus and obesity were registered more often than in the group of those who died from other primary cause (group 3). Oncopathology, miocardial infarction (MI), acute cerebrovascular accident (ACV), bleeding, HIV were registered less often. There were no diff erences in the incidence of thrombosis (6.4% and 5.7%) and COPD (2.4% and 2.9%) in the 2nd and 3rd groups. As the primary cause of death, acute respiratory failure or acute respiratory distress syndrome was indicated most often — 77.3% (93.4% — in the 1st group, 76.6% — in the 2nd and 10.0% — in the 3rd), cardiopulmonary ineffi ciency — 12.3% (5.6%, 18.3% and 15.9% in groups 1–3, respectively), wet brain — 5.2% (0.4%, 3.3% and 33.6% in groups 1–3, respectively).Conclusions. 43% of medical certifi cates of death did not list other diseases/conditions except COVID-19 and pneumonia. In other cases the analysis did not allow to determine whether COVID-19 had been the main cause of death and the contributing cause factor of death in the absence of clear criteria. More than 90% of deaths were registered in people over 50.

Aim: To perform clinical characterization of patients with chronic heart failure (CHF) in the Moscow Region and to assess if their current treatments meet the current clinical guidelines.Materials and methods: Based on the information submitted from 11 outpatient clinics in the Moscow Region in December 2019, we analyzed retrospective data on 286 patients with CHF, including their concomitant diseases, types of assessments and their results, as well as current treatments.Results: The most common concomitant disease was arterial hypertension (95.1% of the patients). 53.8% of the patients had previous myocardial infarction, 37.8%, diabetes mellitus, and 34.6%, atrial fibrillation. Chronic kidney disease was present in 18.5% of the patients, valvular heart disease in 11.9%, and past stroke in 10.5%. Of non-cardiovascular diseases, the most common were gastrointestinal disorders (25.2%), chronic obstructive pulmonary disease or asthma (9.8%), and anemia (5.2%). Only 8% of the patients had one concomitant disease, whereas 72% had 2 to 3 diseases, and 20% had at least 4 concomitant diseases. Mean number of comorbidities per patient was 2.7. Echocardiography had been performed in 82.9% of the cases. Mean left ventricular ejection fraction was 51.0±10.11%; in 11.5% of the patients it was≤40%. Glomerular filtration rate (GFR) was calculated in 58.7% of the patients. 35.9% of the patients had a GFR of less than 60 mL/min/1.73 m2 , in 3.6% it was≤30 mL/min/1.73 m2 . 83.2% of the patients were treated with renin angiotensin aldosterone system blockers (angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, sacubitril/valsartan), 79.0% with beta-blockers, 53.1% with mineralocorticoid receptor antagonists. Glycosides had been administered to 6.9% of the patients, and diuretics, to 51.1%. In most cases, the doses administered were below those recommended by the international clinical guidelines.Conclusion: We have confirmed the need to increase the adherence of doctors to the clinical guidelines on assessment and management of CHF patients.

Chronic heart failure (CHF) is a wide-spread disease (from 7 to 10% in the Russian Federation) and tends to grow. Frequent, repeated hospitalizations of CHF patients are due to insufficient compliance of patients with the treatment and the absence of continuity in management of patients between the hospital and out-patient clinic. Developing a structure of specialized care could provide improvement of treatment quality, a decrease in the number of hospitalizations, and better prognosis. International experience shows that creation of specialized clinics for heart failure improves quality of medical care in CHF and decreases the frequency of re-hospitalizations and mortality. In the Russian Federation, such clinics were created in Nizhniy Novgorod, Ufa, Saint Petersburg, and several other cities. The article presents an expert consensus on the structure, functions, and equipment of departments and offices for patients with heart failure.

Changes in provision of elective care during coronavirus disease 2019 pandemic require search for new forms of doctor-patient communication. Telemedicine technologies have become widely used for monitoring of patients, especially those with noncommunicable diseases. However, the introduction of telemedicine care is associated with a large number of medical, legal and technical issues. Rational use of telecommunication within the modern clinical guidelines will significantly increase the availability of high-quality healthcare and reduce the hospitalization rate for exacerbation of chronic diseases, as well as improve disease outcomes.

The purpose of the study is to analyze the application of I50.9 code as initial cause of death (PBC) in various subjects of the Russian Federation in 2013-2019. The Rosstat data (Annual forms C41 and C51) based on the "Brief Nomenclature of Causes of Death of Rosstat" (KNPSR) in 2013-2019. The standardized mortality rates (SPS) were determined using corresponding software (state registration number 216661114), coefficient of variation (Cv) and the max/min ratio. In 2013-2019, the regional average value of the SCR from cardiac failure (code I50.9) decreased up to 4 times (from 6.3 ± 10.3 to 1.5 ± 3.5; p0.0001), but Сv of regional SCR increased by almost 1.5 times (162% and 230%). The percentage of regions where cardiac failure was not indicated as PPP, increased from 8% in 2013 to 19% in 2019. However, only in the Yaroslavl Oblast and the Republic of Buryatia no case of indicating I50.9 code as PPP was registered. In five regions, less than 10 cases were registered in 7 years, in 3 regions an unstable tendency to increase in SDR from HF was established. In 36 regions, more significant variability of RMS from year to year was recorded. From our point of view, the indices are affected in parallel by teo processes: changes in mortality rates associated with chronic heart failure and changes in mortality rates due to approaches to filling out the MSS and coding PPP. To determine the contribution of cardiac failure into population mortality, it is necessary to separate concepts "chronic cardiac failure syndrome" and "cardiac failure as death mechanism" and to introduce uniform rules of indicating chronic cardiac failure syndrome in the MSS.

The role of heart failure (HF) in mortality rates is ambiguous, and much depends on assessment criteria and accounting potential.Aim. Using medical certificates of cause of death (MCCD), to assess rates of HF, taking into account different types of coronary artery disease (CAD), sex, age and place of death.Material and methods. Data on deceased persons for 2020 were obtained from the electronic database of the Main Department of Civil Registry Office of Moscow Oblast, using the 4-digit codes of the International Classification of Diseases, Tenth Revision (ICD-10). All deaths with CAD codes (I20-25) were selected. A total of 23193 deaths were included in the analysis. The codes and verbal descriptions of complications were assessed and 3 groups were formed: without indication of heart failure (HF), with indication of HF (without chronic HF) and CHF in MCCD. Comparison of the average age of deceased, the proportion of women and men, the detection rates of certain CAD types and the place of death was carried out. Using logistic regression, the probability of chronic HF/HF as a death cause was determined, taking into account other factors.Results. Any HF was indicated in 78,9% of the MCCD (acute CAD — 44,5%, chronic CAD — in 89,1%). Chronic HF was indicated in 27% of the MCCD (men, 30,9%; women, 22,9%; pConclusion. According to the MCCD data, chronic HF is not the dominant complication leading to death. The results obtained require clarification in studies based on primary medical documentation.