DISEASES OF THE CARDIOVASCULAR SYSTEM AS THE LEADING CAUSE OF DEATH IN RUSSIAN FEDERATION: WAYS OF PROBLEM SOLUTION

Abstract

The article presents the current state of the mortality problem due to cardiovascular diseases and demonstrates the heart and vascular diseases morbidity and mortality rates for the period of past seventeen years in the Russian Federation. The World Health Organization data on the risk factors and the cardiovascular diseases prevention methods are presented. The results of the audit of primary medical documentation in the Novgorod region are shown in order to illustrate the problem of providing medical care to the population with the heart and blood vessels pathology. The audit was performed with an eye to identify the flaws in the provision of medical care for this category of patients. A postmortem analysis of 366 medical records was made, for both outpatient and inpatient patients by the profiles of therapy, cardiology and neurology. The age range of them was from 65 to 83 years with the average age of 76 years. The number of women among the patients of presented sample was 235 (64.2%) people. The total duration of hospitalization was 147 hours. Atherosclerotic heart disease (15%), hypertension (15%), angina pectoris (12%), myocardial infarction (10%), post infarction cardiosclerosis (8.6%), acute cerebrovascular accident, ischemic type (17, 4%) and hemorrhagic type (5.5%), were the predominating nosological forms, other diseases were presented by singular cases and amounted to 16.5%. More than 65% of patients had some kind of concomitant pathology and a non insulin dependent diabetes mellitus, which was the cause of cardiovascular diseases. About 25% of patients sought medical care seven days before the outcome. However, they were not hospitalized and died at home. The local general practitioner examination during the first seven days after calling the ambulance also took place in only 25% of cases. In 50% of all the hospitalizations death occurred in the first 24 hours after the admission. It proves a high level of late requests for medical help, when the patients' condition is already agonal and death is inevitable. Based on the results of the analysis, several actions that might be taken in order to solve the problem were proposed. First of all, early identification of high risk patients should be performed, as well as optimization of the emergency medical service work and an advanced training of the primary care physicians should be provided, and finally an assessment of the treatment effectiveness according to the outcome of the disease would help to increase the number of better outcomes