Risk is not a noble cause
“Work with “acute” patients is good, but it is necessary to move towards primary prevention,” said Nadezhda Zvartau, Deputy Director General for Work with the Regions of the Almazov Center, at a round table at the State Assembly of the Republic. of Belarus dedicated to providing medical care to patients with cardiovascular diseases.
It is from diseases of the circulatory system that the largest number of residents in the region die: 41.7%. Among patients with cardiovascular pathology, hypertensive patients predominate. They are identified using new criteria.
According to the head of the Republican Center for Cardiology, Irina Nikolaeva, the number of acute myocardial infarctions has decreased.
– During last year more than 3.6 thousand were identified. 624 people died from myocardial infarction, including a large proportion of patients of working age. As a rule, retirees go to the doctor alone. They are examined and observed, but those who work are left unsupervised. There are more and more patients with chronic heart failure as the average age increases. Those who are constantly monitored by doctors are less likely to be urgently hospitalized and are called an ambulance less often, the head doctor noted.
The republic implements specialized programs for high-risk patients. These are good practices, but most of them are aimed at patients as part of secondary prevention, that is, after the disease has already become public.
– We need to emphasize the continuity of therapeutic and cardiological services. We conducted an in-depth analysis in St. Petersburg and found that when patients with cardiovascular diseases are seen by a cardiologist, mortality is three times lower than when they are seen by a general practitioner,” Nadezhda Zvartau concluded.
At the same time, general mortality and mortality from diseases of the circulatory system in Bashkortostan are lower than the Russian average. To ensure that it continues to decline, Nadezhda Zvartau proposed creating intensive care centers in several large hospitals.
“This is the right step, as confirmed by world practice,” he noted. – In Bashkortostan, the share of deaths from myocardial infarction in complementary hospitals is 28.2%. This suggests that patients who have suffered a heart attack should be sent to vascular centers in a timely manner. Outside hospitals, 34% of patients die from a heart attack, and here it is necessary to carry out active information work so that everyone knows the symptoms of acute cardiovascular diseases.
Just as the doctor prescribed
Those who have suffered a myocardial infarction receive medication for six months and, after a vascular accident, for two years. Taking medications on time is a matter of life.
“The annual mortality rate of patients with myocardial infarction among those taking medication is reduced by half,” said the head of the territorial body of Roszdravnadzor of the Republic of Belarus, Dinara Gashimova. “Unfortunately, the number of requests is increasing due to the lack of medicines, including those intended for the treatment of cardiovascular diseases. In 2022 there were 12, in 2023 – 84, and in 2024, as of March 21, there were already 42. At the same time, medications that patients did not receive on time are written off due to expiration.
To make medication provision a continuous process, changes are being made to the information system used by cardiologists. As Irina Nikolaeva said, a comprehensive matrix system for personalized registration of patients with cardiovascular diseases is being formed. Each patient has a medication supply plan and doctors see which medications need to be purchased in a timely manner so that there are no gaps.
– Every patient with cardiovascular pathology is monitored for life. Everything must happen in a single information space so that there is transparency for the primary care doctor and the specialist doctor. Almost all medical institutions where a patient with cardiovascular diseases may be found are integrated into one system and transmit information in real time, Irina Nikolaeva noted.
But not everything is as simple as we would like. Despite the importance of clinical observation, far less funding has been allocated to it than is necessary. Of an estimated figure of 430 to 450 million rubles, 200 million have been allocated to all beneficiary groups.
Rehabilitation is an ongoing process.
There were also changes in the third stage of treatment – medical rehabilitation after heart attacks and strokes at the Green Grove sanatorium. According to the head doctor of the spa Nail Safiullin, the length of stay this year has been reduced from 14 to 10 days. At the same time, the cost of a bed increased: before it was 2,126 rubles, now it is 2,976 rubles. This stage is financed from the republican budget and applies to the active population. Every year 2,440 people pass through the rehabilitation department.
“In 95% of cases a positive effect is achieved,” says Nail Safiullin. – After further treatment in the sanatorium, patients return to their normal life and work.
Irina Nikolaeva does not see any problems in reducing the time spent in the sanatorium: “After Green Grove, there is still outpatient rehabilitation. Now rehabilitation is a continuous process.”
Of course, being healthy is better than being sick. If something happens, doctors will always come to the rescue; They do this 24 hours a day, often rescuing patients from the other world. But no doctor will do for us what we can do for ourselves: take care of our own condition. The recipe is known: a healthy lifestyle and self-control.
Just the facts
The regional project “Fight against cardiovascular diseases” is being implemented in Bashkortostan. A unified digital platform has been created that allows online monitoring of patients in hospitals with acute conditions, as well as dispensary observation using personal medical assistants. Artificial intelligence technologies began to be used in 2024.
The entire republic is covered for the provision of cardiac care, including surgical care in acute conditions. In 2019-2023, a complete network of vascular centers was formed. There are more regional vascular centers, now there are 10. In addition, in Oktyabrsky and Salavat there are eight primary vascular departments and two private centers.
The institutions are equipped with modern equipment. In particular, thanks to seven angiographic complexes, the availability of medical care has increased. Within the first two hours of initial contact with a healthcare provider, 94% of the adult population receives primary percutaneous coronary intervention (PCI). This is a minimally invasive, non-surgical procedure used to treat coronary artery disease. It is used to place and deploy coronary stents, a permanent tube with wire mesh to open narrowed coronary arteries.
345 medical organizations are licensed in the field of cardiology.
Assistance is provided by 315 cardiologists, 81 cardiovascular surgeons and 75 doctors in endovascular X-ray diagnosis and treatment.
The proportion of specialized hospitalizations increased to 97.7%, the proportion of the population living in the two-hour PCI access zone – to 91.5%, in-hospital mortality from myocardial infarction decreased in five years from 11 .7 to 7.7%.
