Rehabilitation services for patients with acute coronary syndrome in the Krasnoyarsk region

Aim. To evaluate the program of rehabilitation services for patients with ACS over the last six years in the Krasnoyarsk Region.

Methods. Data from the National report on the key performance indicators of the Regional Vascular Centers and Primary Vascular Departments of the Krasnoyarsk Region from 2012 to 2017; National reports on the population health of the Krasnoyarsk Region from 2012 to 2017; reports of the healthcare institutions providing outpatient rehabilitation for patients with ACS in the Krasnoyarsk Region were included in the analysis.

Results. Over the past six years the number of patients with ACS decreased in the Krasnoyarsk Region. There were 15,923 patients suffered from ACS in 2012, in 2013 - 13,119, in 2014 - 11,192, in 2015 - 11,019, in 2016 - 10,985, and in 2017 - 9,903. The number of patients with ACS decreased due to the exclusion of patients with unstable angina (UA), while the number of patients with acute myocardial infarction (AMI) remained constant and varied from 5,000 to 5,500 patients. The majority of ACS patients were treated in the Regional Vascular Centers and Primary Vascular Departments where they successfully underwent Phase 1 of the rehabilitation program. At di, all patients were referred to Phase 2 of the rehabilitation program (in-patient) performed in the sanatorium “Yenissei” and “Krasnoyarsk Zagoije”. Phase 3 of the rehabilitation program was provided in the Center of modern cardiology and Professorial Clinic of Krasnoyarsk State Medical University named after Professor V.F. Voino-Yasenetsky. The number of ACS patients who underwent rehabilitation after hospital discharge increased over the last years: 5.9% - in 2012, 8.8% - in 2013, 11.9% - in 2014, 13.1% - in 2015, 14.4% - in 2016, 17.1% in 2017.

Conclusion. The majority of patients with acute coronary syndrome (76.4-81.2%) underwent Phase 1 (early in-patient) rehabilitation in the Regional Vascular Centers and Primary Vascular Departments. The number of ACS patients who underwent Phase 2 rehabilitation had been increasing annually. Over the past 6 years the percentage of patients had increased from 5.9% to 17.1%. However, only one-sixth of patients with ACS underwent Phase 3 rehabilitation after hospital discharge. Therefore, the improvements in the management of Phase 2 (in-patient) and Phase 3 the (outpatient) through the integration with the regional hospitals of the Krasnoyarsk Region, increase in the numbers of government contracts in Krasnoyarsk, and formation of the reliable continuity between Phase 2 and Phase rehabilitation are required.

1. Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular diseasein Europe: epidemiological update 2016. Eur Heart J 2016; 37 (42): 3232-45. doi: 10.1093/eurheartj/ehw334

2. Demograficheskij ezhegodnik Rossii - 2015. Available at: http://www.gks.ru/bgd/regl/B15_16/Main.htm (in Russian.).

3. I.S.Skopets, N.N.Vezikova, O.Yu.Barysheva, Malafeev A.V, Malygin A.N., Leontyev A.V, Ispravnikova A.AEvaluation of long-term outcomes following acute coronary syndrome in the clinical practice: results of the 5-year follow-up. Cardiosomatics. 2018; 9 (2): 17-23. (in Russian)

4. D.M.Aronov, L.VKozlova, M.G.Bubnova Current state and problems of cardio rehabilitation in Russia. Cardiosomatics. 2017; 8 (3): 4-9. (in Russian)

5. Aronov D.M., Bubnova M.G., Barbarash O.L., Doleckij A.A., Krasnickij V.B., Lebedeva E.V, Lyamina N.P., Repin A.N., Svet A.V, CHumakova G.A.Electrocardiograms with an acute myocardial infarction with raising of ST segment:rehabilitation and secondary prevention. Cardiosomatics. 2014; 5 (S1): 5-41. (in Russian)

6. Bokeriya L.A., Aronov D.M. Russian clinical guidelines Coronary artery bypass grafting in patients with ischemic heart disease: rehabilitation and secondary prevention. Cardiosomatics, 2016; 7 (3-4): 5-71. (in Russian)

7. Erlikh A.D., Barbarash O.L., Kashtalap V.V., Gratsiansky N.A. Compliance with clinical practice guidelines for non ST-segment elevation acute coronary syndrome: association between outcomes and predictors of poor management (RECORD-3 registry data). Complex Issues of Cardiovascular Diseases. 2016; 5(2): 7582. (in Russian)

8. S.A. Boitsov, P.Ya. Dovgalevsky, VI. Gridnev, E.V Oshchepkova, VA. Dmitriyev Comparative analysis of the data of Russian and foreign acute coronary syndrome registries. Cardiology messenger. 2010; 1: 82-86. (in Russian)