Background. Prevalence of atrial fibrillation (AF) grows with the increase in CHF FC and reaches 45% in III-IV FC CHF. With an adequate anticoagulant (AC) therapy, the risk of thromboembolic complications does not significantly differ between patients with I-II FC and III-IV FC CHF. Of particular interest is studying administration of the anticoagulant treatment and correspondence between the SAMe-TT₂R₂ scale and actual TTR values in patients with CHF and AF in real-life clinical practice. Aim. Toanalyze the efficacy of anticoagulant therapy and prognosis in patients with CHF and AF in the setting of real-life clinical practice. Materials and methods. The study included 272 patients with CHF and AF who were discharged from the hospital where they had been treated for decompensated CHF and who were followed up as outpatients for a year. Efficacy of the AC therapy was evaluated; parameters of CHA₂DS₂-VASc, HAS-BLED, and SAMe-TT₂R2 scales were calculated at baseline. TTR was computed to determine the mainte nance time. Results. Patients with CHF had permanent (56.3%), persistent (38.6%), or paroxysmal (5.1%) AF. The mean CHA₂DS₂-VASc score was 3.83±1.16 and the mean HAS-BLED score was 1.3±0.83. SAMe-TT₂R₂ scores were 0 for 1.6% of patients; 1 for 36.9%, and 2< for 61.5%. At baseline, one third of patients with CHF and AF received antiplatelet therapy (APT) and every forth patient received no therapy. At one year, 69.0% of patients took AC on a constant basis (р<0.001), including warfarin (30.4%, р=0.9), NOACs (38.6%, р<0.001), specifically, rivaroxaban (22.8%, р<0.001), dabigatran (9.8%), and apixaban (6.0%). All-cause mortality was 6.4% for patients with CHF and AF who received anticoagulants whereas it was 2.2 times higher with any antiplatelet therapy or no therapy (р=0.03, OR=2.4; 1.0-5.7). One-year cardiovascular mortality was 3.7% for the AC treatment group and 3.2 times higher for the APT and no therapy group (р=0.01, OR=3.5; 1.3-9.5). The TTR index >70% was observed for 12.6% patients receiving warfarin. One female patient from the NOAC group had fatal GI bleeding. Non-fatal bleeding was observed 1.3 times more frequently during the warfarin treatment (OR=1.3; 0.2-9.2; р=0.8). Conclusion. Most patients with CHF and AF had high CHA₂DS₂-VASc values and low HAS-BLED values. In real-life outpatient practice, there is a gap between clinical recommendations and reality. Maintaining sufficient TTR values in patients with CHF and AF receiving warfarin is not always possible, which supports the priority of NOAC treatment.

Aim. To determine a possibility for improving the capability of patients with chronic heart failure (CHF) for self-care and self-control using a remote monitoring platform on a basis of mobile application. Materials and methods. The study included 142 patients with CHF of different etiology. During the stay in hospital, patients attended structured classes on different aspects of self-control and self-care in CHF. The group of active management consisted of 47 patients who subsequently used a version of mobile application. The control group consisted of 95 patients with CHF. The remote monitoring platform was based on a translated to Russian version of the European Heart Failure Self-Care Behavior Scale (EHFScBS_9), which included 9 items addressing different issues of selfcontrol. Responses were presented as a scale ranging from “completely agree” (1) to “completely disagree (5). The total score was calculated by adding scores for each item. The lower the score the better was the capability of CHF patients for self-care. The follow-up duration was 6 months. Results. On admission, the mean EHFScBS_9 score decreased to 15±2.3 in the mobile application group whereas in the control group, the mean score was 23.95±3.02, which indicated a significantly better capability for self-care in the mobile application group (p<0.001). Conclusions. Using the developed by us remote monitoring platform mounted on a mobile application on the basis of EHFScBS_9 increased the patients’ compliance with recommendations and their capability for self-care and also allowed to optimize monitoring of disease symptoms.

The article analyzes some characteristics of hospitalized patients with decompensated chronic heart failure (HF) according to data from Russian and international registries, management of decompensated HF, and tactics for titration of evidence-based disease-modified therapies. The demographic characteristics of the patients from the registers that were used for the research are similar. Yet, the proportion of HF patients with preserved LVEF was greater according to data from several Russian studies. Meanwhile, with the patients that did not receive any loop diuretics and therefore had apparently no congestion signs being excluded from the analysis, the proportion of HF patients with preserved LVEF became similar to that from the international studies. The registers also showed that pulmonary edema and acute left ventricular failure were observed in less than a half of the cases. Nevertheless, patients with mild congestion symptoms still have bad lingering prognosis and require the same amount of medical attention. Up to 40% of admissions for decompensated CHF resulted from a dietary disorder (excessive sodium consumption), low compliance with therapy and lack of access to primary care providers. Furthermore, the analysis of the outpatient treatment administered prior to the forthcoming hospitalization showed a low prescription rate of evidence-based disease-modifying therapies (ACEi or ARNi, BB, MRA). It is emphasized that in part of patients the administration and/or titration of this therapy can be started during hospitalization. The article also discusses the use of a new class of drugs, angiotensin receptor-neprilysin inhibitors (ARNi), including not only transferring patients from ACEi to ARNi but also the possibility of administering ARNi to stable, hospitalized patients who do not require intravenous diuretics and inotropic drugs.

Chronic heart failure following chemotherapy for cancer is a relevant issue of an adverse cardiovascular prognosis and premature death in cancer patients. This category of patients requires thorough and chronic monitoring of the cardiovascular system, prevention and treatment of cardiovascular complications of chemotherapy, such as IHD, systolic or diastolic myocardial dysfunction, arterial or pulmonary hypertension, pulmonary thromboembolism, pericarditis, stroke, and peripheral vascular disease. However, many aspects of this important interdisciplinary issue presently remain understudied. For instance, it is still impossible to predict long-term consequences of chemotherapy for cancer and development of the associated cardiovascular complications listed above. Baseline evaluation of the risk for cardiovascular complications is a major component in management of such patients. High-risk patients need an individual, detailed schedule of cardiovascular treatment throughout and after the course of chemotherapy. Furthermore, early detection of subclinical myocardial dysfunction is critical for prevention of the most threatening cardiovascular complications of chemotherapy, CHF. Detecting impaired LV EF following chemotherapy is, unfortunately, only a late predictor of irreversible changes, such as toxic cardiomyopathy and clinically pronounced, rapidly progressing CHF. Markers of myocardial injury, high-sensitivity troponins and natriuretic peptides, in combination with up-to-date EchoCG technologies have been recently used. Their use, for instance, for evaluation of LV myocardial global longitudinal strain to detect early, reversible changes in structure and mechanics of the myocardium is promising for ultimate improvement of prediction for such patients.

Ue review focused on the prognostic significance of hyperglycemia and glycemia variability in patients both with type 2 DM and without previously detected disorders of carbohydrate metabolism hospitalized for decompensated CHF. Results of recent studies of glycemia variability, stress-induced hypoglycemia, and their effect on prognosis for patients with decompensated CHF were analyzed.

Patients with coronary heart disease (CHD) and abdominal obesity (AO) are a priority group for the most active implementation of secondary prevention efforts. The paper focuses on most challenging issues of cardiovascular risk factors (RFs) correction via comprehensive cardiac rehabilitation (CR) programs in patients with CHD and AO. Based on large randomized clinical trials results, intensive behavioral interventions in the form of counselling are beneficial for such patients especially during the long-term support stage. They produce small but important changes in health behaviors (which translate into weight reduction, more healthy nutrition and higher physical activity) and improve selected intermediate clinical endpoints.

Modern treatment of patients with oncohematological diseases has allowed to achieve remission or even convalescence in many cases. One of ambitious aims put forward by the hematological society is 100% survival and preservation of quality of life in patients with chronic myeloid leukemia (CML). This hope is related with the emergence of targeted therapy for CML. The second-generation tyrosine kinase inhibitor, dasatinib, which is used for treatment of CML, can occasionally induce severe pulmonary hypertension (PH). We presented here a case report of such cardiotoxicity, which was evident as PH and heart failure in a young female patient with CML treated with dasatinib. Information from published reports about this type of cardiotoxicity is provided. At present time, dasatinib is beginning to be extensively used also in other oncological diseases. For this reason, cardiologists and physicians should be aware of this cardiotoxicity, which can cause heart failure in dasatinib-treated patients.