Elena Frolova

A Roadmap of Aging in Russia: The Prevalence of Frailty in Community-Dwelling Older Adults in the St. Petersburg District—The “Crystal” Study

OBJECTIVES: To categorize the health problems of older Russians and identify the number of frail older adults using different approaches.

The impact of a nurse-led care programme on events and physical and psychosocial parameters in patients with heart failure with preserved ejection fraction: A randomized clinical trial in primary care in Russia

Abstract Background: Disease management programmes (DMPs) improve quality of care for patients with heart failure (HF). However, only a limited number of trials have studied the efficacy of such programmes for patients with heart failure with preserved ejection fraction (HFPEF). Objective: To estimate the impact of a structured, nurse-led patient education programme and care plan in general practice on outcome parameters and events in patients with HFPEF. Methods: Single blinded randomized clinical trial with an intervention over six months and a follow-up during 12 additional months. In the control group, the patients (n = 41) were managed according to Russian national guidelines. Patients in the intervention group (n = 44) received education on individual lifestyle changes and modifications of cardiovascular disease (CVD) risk factors, home-based exercise training and weekly nurse consultations in addition to usual care. Results: Six months after their inclusion, patients in the intervention group significantly improved body mass index, waist circumference, six-min walk test distance, total cholesterol, low-density lipoprotein, left ventricular end-diastolic volume index, quality of life and level of anxiety. After 18 months, there were 11 deaths (25%) or hospitalizations in the intervention group and 12 (29%) in the control group (P = 0.134). Cardiovascular mortality and readmission rate were not reduced significantly after six months of follow-up: the hazard ratio was 0.47 (95% CI: 0.17–1.28; P = 0.197). After 18 months, this was 0.85 (0.42–1.73; P = 0.658). Conclusion: This primary care based DMP for patients with HFPEF improved the patients’ emotional status and quality of life, positively influenced body weight, functional capacity and lipid profile, and attenuated heart remodelling.

Predictors of poor-quality spirometry in two cohorts of older adults in Russia and Belgium: a cross-sectional study

Background:Spirometry is an important test for the diagnosis of respiratory diseases, yet it is underused especially in older adults. Several predictors of good-quality spirometry in this age group have been reported, based mainly on in/outpatients of geriatric and/or respiratory units.Aims:This study aims to assess predictors of poor-quality spirometry in community-dwelling older adults from two primary care cohorts in Russia and Belgium.Methods:Spirograms from two population-based cohort studies in Russia (CRYSTAL) and Belgium (BELFRAIL) were assessed in accordance with the American Thoracic Society/European Respiratory Society (ATS/ERS) acceptability and repeatability criteria and grouped into good and poor quality. Multivariable analysis assessed the association of poor-quality spirometry with socio-demographics, functional dependency, physical and mental functioning and co-morbidities.Results:In all, 43.3% of the 522 BELFRAIL participants (84.71±3.67 years old) and 57.7% of the 605 CRYSTAL participants (75.11±5.97 years old) achieved all ATS/ERS acceptability and repeatability criteria. In both cohorts, those with poor-quality spirometry had lower cognitive function (mini-mental state examination (MMSE) ⩽24). After adjustment in multivariable analysis, MMSE ⩽24 had an odds ratio for poor-quality spirometry of 1.33 (95% CI=0.78–2.28) in the BELFRAIL and 1.30 (95% CI=0.88–1.91) in the CRYSTAL cohort.Conclusions:In community-dwelling older adults, including those over 80 years old, impaired cognition measured by the MMSE may not be an independent predictor of poor-quality spirometry. Further research is needed in this area, and spirometry should be used more often in older adults in primary care.

The relationship between physical performance and cardiac function in an elderly Russian cohort.

This study aims to determine the cardiac dysfunction prevalence, to investigate the relationship between the Short Physical Performance Battery (SPPB) test and structural and functional echocardiographic parameters and to determine whether SPPB scores and cardiac dysfunction are independent mortality predictors in an elderly Russian population. A random sample of 284 community-dwelling adults aged 65 and older were selected from a population-based register and divided into two age groups (65-74 and ≥75). The SPPB test, echocardiography and all-cause mortality were measured. The prevalence of cardiac dysfunction was 12% in the 65-74 group and 23% in the ≥75 group. The multivariate models could explain 15% and 23% of the SPPB score total variance for the 65-74 and ≥75 age groups, respectively. In the younger age group, the mean follow-up time was 2.6±0.46 years, and the adjusted hazard ratio (HR) for risk of mortality from cardiac dysfunction was 4.9. In the older age group, the mean follow-up time was 2.4±0.61 years, and both cardiac dysfunction and poor physical performance were found to be independent predictors of mortality (adjusted HR=3.4 and adjusted HR=4.2, respectively). The cardiac dysfunction prevalence in this elderly Russian population was found to be comparable to, or even lower than, reported prevalences for Western countries. Furthermore, the observed correlations between echocardiographic abnormalities and SPPB scores were limited. Cardiac dysfunction was shown to be a strong mortality predictor in both age groups, and poor physical performance was identified as an independent mortality predictor in the oldest subjects.

Management of patients with atrial fibrillation in general practice

The lecture presents modern concepts of diagnosis and treatment of atrial fibrillation; principles of choosing the tactics of management of atrial fibrillation in general practice. The epidemiology of atrial fibrillation, risk factors, causes and mechanisms of its development are considered. The classification of atrial fibrillation is given. The tactic of diagnosis of atrial fibrillation is described. The principles of treatment of atrial fibrillation, including the anticoagulant therapy and pharmacological cardioversion, are presented.

The classification of acute myocardial infarction types and the preconditions for its development. Type II myocardial infarction

The article presents the concept of myocardial infarction of the second type in the context of the universal definition of acute myocardial infarction. The problem of differential diagnosis for heart attacks first vs. the second types is discussed.

Validation of a new mortality risk prediction model for people 65 years and older in northwest Russia: The Crystal risk score.

BACKGROUND Prediction models help to make decisions about further management in clinical practice. This study aims to develop a mortality risk score based on previously identified risk predictors and to perform internal and external validations. METHODS In a population-based prospective cohort study of 611 community-dwelling individuals aged 65+ in St. Petersburg (Russia), all-cause mortality risks over 2.5 years follow-up were determined based on the results obtained from anthropometry, medical history, physical performance tests, spirometry and laboratory tests. C-statistic, risk reclassification analysis, integrated discrimination improvement analysis, decision curves analysis, internal validation and external validation were performed. RESULTS Older adults were at higher risk for mortality [HR (95%CI)=4.54 (3.73-5.52)] when two or more of the following components were present: poor physical performance, low muscle mass, poor lung function, and anemia. If anemia was combined with high C-reactive protein (CRP) and high B-type natriuretic peptide (BNP) was added the HR (95%CI) was slightly higher (5.81 (4.73-7.14)) even after adjusting for age, sex and comorbidities. Our models were validated in an external population of adults 80+. The extended model had a better predictive capacity for cardiovascular mortality [HR (95%CI)=5.05 (2.23-11.44)] compared to the baseline model [HR (95%CI)=2.17 (1.18-4.00)] in the external population. CONCLUSION We developed and validated a new risk prediction score that may be used to identify older adults at higher risk for mortality in Russia. Additional studies need to determine which targeted interventions improve the outcomes of these at-risk individuals.

CLINICAL CHARACTERISTICS IN THE ELDERLY PATIENTS WITH BRONCHO-OBSTRUCTIVE SYNDROME

The analysis of clinical features (age, sex, dyspnoe, smoking status, symptoms of heart failure, etc) was done in the elderly with broncho-obstructive syndrome identified with spirometry. Bronchial obstruction revealed if a fixed ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) was less than 0,70 (70%). Spirometry was performed in 605 people. Frequency of airflow limitation (FEV1/FVC < 0,70) in the sample was 20% (95% CI = 17%-24%), and increased with age. Patients with broncho-obstructive syndrome showed no clinical features which could physician to rely on in diagnosing broncho-obstructive syndrome without spirometry.

EURACT: EUROPEAN ACADEMY OF TEACHERS IN GENERAL PRACTICE/FAMILY MEDICINE ‘Ask the Expert!’ – a new EURACT project

As stated in the Articles of Association of the European Academy of Teachers in General Practice/Family Medicine (EURACT), the aim of the academy is to foster and maintain a high standard in European primary health care by the promotion of study and education in general practice. This can be achieved by nine diff erent tasks, amongst which are ‘ Providing support and information for Academy members ’ and ‘ Establishing a communication network between members. ’ From 1 June 2013, EURACT members have been provided with the opportunity to communicate with experts in diff erent fi elds of education through the ‘ Ask the expert! ’ project. The aim of this project is to provide timely informational support for EURACT members, using the intellectual potential of EURACT council members and their great wealth of information regarding knowledge, skills, and links. The project has established a monthly roster of Council members on the website (http://www.euract.eu) as experts with the responsibility of receiving questions and requests from EURACT members and answering them through e-mail. The participating experts need to prepare a short report for each sixmonthly Council meeting about their activities, i.e. the numbers of questions, contents, diffi culties and so on. Each year an evaluation of the project will be carried out through the analysis of these activities as part of EURACT ’ s drive towards becoming a more open and dynamic organization!

ISCHEMIC RISK STRATIFICATION IN NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROME

The current recommendations of European Society of Cardiology for ischemic risk stratification in patients with Non-ST-Segment Elevation Acute Coronary Syndrome are presented.