CARDIOLOGICAL SERVICE OF THE IRKUTSK REGION - RESULTS OF 2022 AND DIRECTIONS OF DEVELOPMENT
Authors:   ", Khramtsova Natalia Anatolyevna ,   Irkutsk Regional Order of the Badge of Honor",   Clinical Hospital, Irkutsk State Medical Academy of Postgraduate Education - – Branch Campus of the FSBEI FPE RMACPE MOH Russia, Irkutsk Russian Federation
Published: October 2023

At the end of 2022, there were several positive trends in the performance of the cardiology service. Thus, mortality from circulatory system diseases (CVD) in the Irkutsk region, according to Rosstat, decreased by 4.3% compared to 2021 and amounted to 676.3 per 100,000 population. The mortality rate from MI also decreased and reached 52.9 per 100,000 population. According to the results of the year, a decrease in the total number of deaths from myocardial infarction by 145 people was noted. The proportion of hospitalizations in specialized departments of PSO and RSC increased by 6.2%, which led to a significant decrease in the number of patients who died from myocardial infarction (MI) outside the specialized departments (-54.3%). The total number of patients with acute coronary syndrome (ACS) hospitalized in specialized departments (RCC and PSO) out of all patients with ACS increased by 13.9%. The number of patients with ST-elevation ACS who underwent reperfusion therapy, both primary PCI up to 52.6%, and after thrombolytic therapy (TLT) increased. The number of X-ray endovascular interventions on the coronary arteries for medical purposes increased by 35%, on an accrual basis by the end of the year, the figure was 3952 manipulations. At the end of the year, there was a decrease in mortality from MI by 12.7%, and the figure was 10.3%, which is one of the lowest values in the Siberian Federal District. A decrease in hospital mortality from MI was recorded both in the medical organizations of the region by 2.4%, and in PSO and RSC - by 3.3%. The coverage of dispensary observation and preferential drug provision for patients after MI, coronary artery bypass grafting, radiofrequency ablation, coronary artery stenting and stroke was 92.2%. A remote ECG system for planned patients has been introduced in the region (more than 20,000 consultations have been carried out). The format of round-the-clock reception and interpretation of ECG in patients with ACS is preserved to determine the tactics of management and routing of patients. These possibilities are necessary for making decisions on timely thrombolytic therapy at the stages of evacuation of a patient with ACS and ST segment elevation. Of the problematic aspects, there is a continuing increase in mortality from coronary heart disease by 8.1% and an increase in the number of deaths from coronary artery disease outside medical organizations. The problem of increasing mortality from chronic cardiovascular diseases is due to defects in medical examination and dispensary observation at the outpatient stage. Shortcomings in the work of primary care resulted in high mortality from coronary artery disease, myocardial infarction, CHF at home, insufficient coverage of patients with CVD by dispensary observation and poor quality of dispensary appointments. Of the main priority areas in the work of the cardiological service for the next year, the following should be highlighted: control over the implementation of clinical guidelines (recurring training and testing of doctors, paramedical personnel according to clinical recommendations, multi-level examination of the quality of medical care, the introduction of medical decision support services into practice); optimizing the routing of patients with ACS and other cardiovascular diseases to the specialized departments of the region (organization of interaction between the emergency medical service, the center for disaster medicine and medical organizations in the region, eliminating time losses during the evacuation of patients with ACS, daily monitoring of hospitalizations of the region's ACS); increase in the number of pre-hospital thrombolysis in patients with ACS with ST-segment elevation (training of paramedics and doctors of mobile ambulance teams in ECG interpretation skills and first aid skills in ACS (simulation-training cycles), the widespread introduction of a “second opinion” on ECG, the presence of thrombolytics in packing SMP, daily monitoring of prehospital thrombolysis by heads of medical organizations); development of remote telemedicine technologies; control over preferential drug provision (organization of succession between the hospital and the clinic, ensuring timely (within 72 hours) placement for dispensary observation of patients of the category of Order No. 639n, control of adherence to the prescribed therapy, exclusion of unreasonable de-escalation of doses, cancellation / replacement of drugs. at the outpatient stage, maintaining a register of DLO); dispensary observation (DN) of patients with CVD (registration in MIS of certain groups of patients with CVD for the possibility of automatic generation of lists for DN, proactive invitation to DN of patients with CVD according to a pre-formed list for examination as soon as possible). Thus, the main areas of work for primary care physicians are focused on quantitative and qualitative indicators of medical examination and dispensary observation, with the creation in each polyclinic of a system for monitoring subsidized drug provision and a system for registering high-risk patients. For the ambulance stage, strict adherence to the routing and rapid delivery of patients with ACS is required, with pre-hospital thrombolysis, training of doctors / paramedics in emergency cardiology and the introduction of a remote ECG system. At the inpatient stage of medical care, continue work to improve the profile of treatment of CVD patients by minimizing hospitalizations in therapeutic departments, for this purpose, the creation of interdistrict cardiology departments, the introduction of clinical recommendations on cardiology into wide practice and control over the continuity of care with the outpatient link.