Vol 98, No 1 (2026): Outpatient care issues and organization of medical care

The increasing burden of chronic non-communicable diseases, rising comorbidity, and population ageing are enhancing the role of outpatient care within healthcare systems. This article outlines the key clinical and organizational priorities of ambulatory medical care and highlights the importance of interdisciplinary and personalized approaches to the management of patients with chronic diseases.

More than one million women in Russia enter menopause each year. The severe estrogen deficiency associated with this transition causes symptoms that significantly impair quality of life and contribute to an increased risk of cardiovascular and metabolic diseases. Menopausal hormone therapy (MHT) is the established standard of care for menopausal symptoms. On the initiative of several professional societies (the Russian Society of Obstetricians and Gynecologists, the Russian Society of Cardiology, the Russian Association of Endocrinologists, the Eurasian Association of Therapists, the Russian Society of Gynecological Endocrinology and Menopause, the Russian Association of Gerontologists and Geriatricians, the Association of Phlebologists of Russia), a Delphi panel was convened to develop a multidisciplinary expert consensus on MHT for patients with cardiovascular and metabolic diseases. The goal was to enhance research and clinical approaches to managing menopausal women. A consensus was reached at the end of the first Delphi round. The experts agreed that initiating MHT requires a thorough assessment of individual risks, including cardiovascular health and comorbidities. MHT can offset metabolic and cardiovascular risk factors in peri- and postmenopausal women by normalizing the lipid profile, improving carbohydrate metabolism, and reducing insulin resistance. An interdisciplinary approach allows for personalized MHT, minimizes potential complications, improves the quality of life for peri- and postmenopausal women, and promotes active longevity.

Background. Patients with acute decompensation of heart failure (ADHF) have a poor prognosis. According to various sources, hospital mortality is 6–8%, and up to 25% of patients require re-hospitalization within the first 3 months after discharge. Prognosis assessment and identification of high-risk groups have been the focus of HF specialists worldwide in recent years.

Aim. To assess the role of clinical, history, laboratory, and instrumental risk factors for the development of adverse events within a year after ADHF.

Materials and methods. A retrospective study evaluating medical records (medical charts) included 374 patients aged 18 years or older hospitalized with ADHF. All patients had clinical severity scores greater than 8.5 (NYHA IV) at admission. A comparative analysis of clinical and history data and in-hospital instrumental and laboratory parameters was conducted; outcomes were assessed 1 year after the ADHF episode, namely, repeated hospitalizations for ADHF after discharge and/or death from all causes.

Results. During 12 months of follow-up, 81 (27.6%) patients had at least 1 adverse event. Using Cox regression, the four most significant factors for an unfavorable 1-year outcome were determined: anemia (risk ratio – RR 1.57 [95% confidence interval – CI 1.01–2.46]), age over 65 years (RR 1.85 [95% CI 1.18–2.91]), sodium level less than 135 mmol/L at the first measurement (RR 1.86 [95% CI 1.07–3.23]), and male gender (RR 2.0 [95% CI 1.11–3.67]). The C-index of the obtained regression was 0.636 (95% CI 0.575–0.697), and the area under the ROC-curve was 0.658 (95% CI 0.607–0.706).

Conclusion. According to the study results, age over 65 years, male sex, hyponatremia, and anemia on admission can be regarded as factors of unfavorable 1-year prognosis in patients after an ADHF episode.

Aim. To characterize the features of the course of decompensated heart failure in hospitalized elderly patients depending on the domains (clinical, psychocognitive, functional and social), as well as to study the effect of the number of domains on the prognosis.

Materials and methods. A prospective study included 150 patients over 75 years old [median age (IQR) 83.0 [77.8–87.0] years, 38% (n = 57) were men] admitted to a multidisciplinary hospital for chronic heart failure (CHF) decompensation, who were assessed for the prevalence of HFA-ESC domains (2019) – clinical, psychocognitive, functional and social. All patients underwent traditional laboratory and instrumental examination, NT-proBNP testing, echocardiographic examination, as well as body composition was assessed using bioimpedance analysis on the 5th day of hospitalization. The combined endpoint was a combination of death from all causes and repeated hospitalizations for CHF within 180 days.

Results. 96.7% (n = 145) of senile patients with CHF had at least one domain of senile asthenia, the presence of all four domains was observed in more than a third of patients. Disorders in the psychocognitive and social spheres were the most common – 88.7% (n = 133) and 74.0% (n = 111), respectively, and clinical and functional domains were less common in 64.0% (n = 96) and 56.7% (n = 85) of patients, respectively. Patients with a large number of domains were characterized by an older age, a greater degree of physical activity restriction and the severity of CHF symptoms, were more often unmarried (including widowers, single and divorced), and most patients lived in a nursing home. A greater number of domains of senile asthenia was associated with a higher incidence of events for the combined endpoint – all-cause death and/or repeated hospitalization for CHF (Log Rank 10.76; p < 0.03). In a comprehensive analysis, the presence of all four domains of fragility syndrome increases the risk of combined events from the primary endpoint by 2.5 times (odds ratio 2.5; 95% confidence interval 1.1–5.7, p < 0.05), hospital mortality by 14.7 times (odds ratio 14.7, 95% confidence interval 3.3–66.4; p < 0.05).

Conclusion. A domain-based approach to determining the severity and prognosis of CHF in "fragile" senile patients seems to be a necessary and convenient tool for identifying a special group of patients at high risk of unfortunate outcome that requires a multidisciplinary approach together with a geriatric team.

Aim. To evaluate major cardiovascular complications in chronic lymphocytic leukaemia (CLL) patients receiving ibrutinib, and to characterise those with new-onset atrial fibrillation (AF) during ibrutinib therapy, examining their outcomes in a real-world clinical setting.

Materials and methods. A retrospective analysis of the medical records of 641 patients diagnosed with CLL who were treated with ibrutinib at the haematology centre of the Botkin Moscow Multidisciplinary Scientific and Clinical Center from 2013 to 2024 was conducted. The primary endpoint of the study was the occurrence of atrial fibrillation during ibrutinib therapy. The secondary endpoint of the study was thrombotic and haemorrhagic complications. To assess the impact of AF on patient outcomes, a comparison was made between patients with AF and those without AF based on sex and age. A composite endpoint was used to evaluate outcomes, which included cardiovascular death and fatal bleeding.

Results. The incidence of new-onset AF in patients receiving ibrutinib therapy during the five-year was 15%. Patients with AF occurring during ibrutinib therapy were found to be older and characterised by the presence of standard risk factors for AF. No significant differences were observed in the characteristics of CLL and its treatment. The occurrence of AF during ibrutinib therapy was associated with a fourfold increased risk of thrombotic complications (OR 4.071, 95% CI 1.837–9.024; p < 0.001), including an increased incidence of fatal pulmonary embolism (p = 0.035) with a comparable incidence of fatal bleeding.

Conclusion. The incidence of AF in patients with CLL receiving ibrutinib is significantly higher than the incidence of AF in elderly patients without CLL. The occurrence of new-onset AF during ibrutinib therapy has been observed to be associated with an increased incidence of thrombotic complications, including fatal thrombotic complications. The incidence of fatal haemorrhagic complications has been noted to be comparable.

The article describes the pathophysiological ground of the relationship between chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVDs), the prevalence and prognostic significance of this comorbidity, as well as the optimal treatment of concomitant CVD and COPD. A review of the current literature is provided, including the results of large cohort, observational studies and meta-analyses on the epidemiology, pathophysiological mechanisms, clinical outcomes, and specific features of the treatment of concomitant CVD and COPD. It is shown that the prevalence of CVD in patients with COPD is 25–70%, which is 2–5 times higher than in the general population. It was found that the pathophysiological relationship between COPD and CVD is due to smoking, age, sex, and other common risk factors, as well as systemic inflammation, oxidative stress, endothelial dysfunction, hypoxemia, activation of the sympathetic nervous system, and pulmonary hyperinflation. Modern triple inhalation therapy (long-acting anticholinergics/long-acting â₂-agonists/inhaled glucocorticosteroids) has demonstrated advantages over dual therapy (long-acting â₂-agonists/long-acting anticholinergics) in reducing overall mortality (hazard ratio 0.66–0.76) as well as the risk of acute cardiovascular events and cardiovascular mortality (hazard ratio 0.52–0.455). It is concluded that the optimization of inhalation therapy, in particular the administration of triple therapy to patients at high risk of COPD exacerbations, contributes not only to improving COPD control, but also to reducing cardiovascular risks and mortality.

The twentieth century marked a golden age for endocrinology, particularly in the methods used to treat type 1 diabetes mellitus. One of the most significant advancements during this period was the development of the insulin pump. This technology, which initially adhered to the original principles and goals of diabetes management, has undergone a remarkable evolution. The transition from large, impractical devices that were suitable only for research in clinical settings, and often associated with complications, to portable, user-friendly, and safe devices has been substantial. This evolution has facilitated the integration of insulin pumps into everyday clinical practice. A detailed examination of the journey from the first prototype of the insulin pump to the models developed by the early 1990s illustrates how researchers overcame numerous challenges. Their efforts laid the groundwork for contemporary understandings of pump insulin therapy and the realization of the aspiration for an artificial pancreas.