Kontsevaya Anna, Bobrova Natalia, Barbarash Olga, Duplyakov Dmitry, Efanov Alexey, Galyavich Albert, Frants Maria, Khaisheva Larisa, Malorodova Tatyana, Mirolyubova Olga, Nedbaikin Andrei, Osipova Irina, Platonov Dmitry, Posnenkova OIga, Syromiatnikova Liudmila, Bates Katie, Leon David A, McKee Martin
Department of Non-Communicable Disease Epidemiology, National Research Center for Preventive Medicine, Moscow, Russian Federation.
London School of Hygiene and Tropical Medicine, London, UK.
Wellcome Open Res. 2017 Sep 25;2:89. doi: 10.12688/wellcomeopenres.12478.2. eCollection 2017.
Death rates from cardiovascular disease in Russia are among the highest in the world. In recent years, the Russian government has invested substantially in the healthcare system, with a particular focus on improving access to advanced technology, especially for acute myocardial infarction (AMI). This protocol describes a study to understand the management of AMI in different Russian regions, investigating the role of patient, clinical, and health system characteristics.
A prospective observational study has recruited a representative sample of AMI patients from 16 hospitals in 13 regions across Russia. Criteria for inclusion are being aged 35-70 years with a confirmed diagnosis of AMI and surviving until the day after admission. Information being collected includes health system contacts and features of clinical management prior to the event and in the 12 months following discharge from hospital. Following initial exploration of the data to generate hypotheses, multilevel modelling will be applied to assess the role of these characteristics in both treatment decisions and any delays in time critical interventions. Between June 2015 and August 2016, 1,122 patients have been recruited at baseline and follow-up to 12 months post-discharge is scheduled to be completed by autumn 2017. The study is unique in examining patient factors, clinical management prior to admission and in hospital in the acute phase and throughout the critical first year of recovery across a diverse range of geographies and facilities. It uses standardized instruments to collect data from patients and health care providers and includes regions that are diverse in terms of geography and development of cardiology capacity. However, given the limited health services research capacity in the Russian Federation, it was not possible to obtain a sample that was truly nationally representative.
俄罗斯心血管疾病死亡率位居世界前列。近年来，俄罗斯政府在医疗体系投入巨大，尤其注重提高先进技术的可及性，特别是针对急性心肌梗死（AMI）。本方案描述了一项旨在了解俄罗斯不同地区急性心肌梗死管理情况的研究，调查患者、临床及卫生系统特征所起的作用。
一项前瞻性观察性研究从俄罗斯13个地区的16家医院招募了具有代表性的急性心肌梗死患者样本。纳入标准为年龄在35至70岁之间，确诊为急性心肌梗死且存活至入院次日。收集的信息包括卫生系统接触情况以及事件发生前和出院后12个月内的临床管理特征。在对数据进行初步探索以生成假设后，将应用多水平模型来评估这些特征在治疗决策和关键时间干预延迟方面所起的作用。2015年6月至2016年8月，已招募了1122名基线患者，计划于2017年秋季完成出院后12个月的随访。该研究的独特之处在于，它在不同地理区域和医疗机构中，考察了患者因素、入院前及急性期住院期间以及整个关键康复第一年的临床管理情况。它使用标准化工具从患者和医疗服务提供者处收集数据，涵盖了地理和心脏病学能力发展各异的地区。然而，鉴于俄罗斯联邦卫生服务研究能力有限，无法获得一个真正具有全国代表性的样本。
