Сreation of a register of patients with acute coronary syndrome in the Amur Region, a region with a low population density. First results

Introduction. The problem of regions with low population density in the aspect of providing medical care to patients with coronary heart disease is extremely relevant due to the insufficiently solved problems: (1) long-term transportation (evacuation) of a patient with acute forms of the disease; (2) difficulty in dispensary supervision of patients with a high risk of fatal cardiovascular events; (3) lack of up-to-date information on the somatic status of this cohort of patients. The above creates difficulties in making managerial decisions aimed at the «frugal» use of resources in the organization of medical care. The creation of the program «Monitoring the condition of patients who have had acute coronary syndrome» (hereinafter referred to as the program, the register) in the conditions of the Amur Region, characterized by a low population density, is due to the need to achieve effective prevention of repeated vascular events. Regular monitoring contributes to the early detection of signs of recurrence of coronary complications, timely correction of therapy, and reduction of the risk of re-hospitalizations due to life-threatening conditions. The maintenance of the register is regarded as an optimal tool for the dynamic assessment of the condition of patients with coronary heart disease and improving the quality of medical care provided to this category of patients. According to the researchers, the implementation of this program allows for a personalized approach to patient management and improves the efficiency of healthcare resources in the region. The purpose of the study: to evaluate the effectiveness of the organizational aspects of providing medical care to patients who have had acute coronary syndrome at the outpatient stage in the Amur Region, a region with a low population density. Research objectives: (1) to explore the possibilities of introducing a specialized program (register) for monitoring patients who have had acute coronary syndrome, in order to: early diagnosis of symptoms of complications, timely correction of therapeutic measures, and reducing the risk of repeated hospitalizations; (2) to study the impact of the register implementation on: the regularity of blood pressure and heart rate monitoring, patient involvement in the treatment process, the frequency of achieving treatment targets, and the timely identification of patients at risk for further medical interventions; (3) to analyze the systematization and structuring of patient data using a register to improve the effectiveness of management decisions on the prevention of coronary complications and the rational use of healthcare resources in the region. Materials and methods. The observation is based on data from patients who had an acute coronary syndrome and were discharged from the register. As of July 2025, 520 patients had been added to the register, and 386 of them were included in the study, with at least 4 months of follow-up at the outpatient stage. The operator collected information through an audio call, asking the patient questions according to a script. Based on the patient’s responses, the register program automatically generated an algorithm of actions for the operator. The necessary patient data was displayed in a tabular format for ease of use and efficiency. The result of this work was the presentation of statistical data on the condition of patients who were discharged from the hospital after an acute coronary event and were under remote monitoring, as well as the organization of their medical care in outpatient settings. Results. In the «register group,» the patients’ conditions were more stable. The proportion of patients who filled out a diary of their blood pressure and heart rate measurements was higher in this group. The achievement of blood pressure targets was also more successful in this group, as the program allowed for the identification of patient risks and the timely referral to a doctor for treatment adjustments. The «register group» was more likely to adhere to regular follow-up appointments, both for patients with complicated and uncomplicated disease courses. These patients were more engaged in the treatment process. Conclusion. The introduction of the register has made it possible to optimize health monitoring, monitor the patient’s condition, systematize data on the course of the disease, more precisely identify patients who require an in-person visit to a doctor for additional examination, therapy adjustment, or referral for surgical treatment, and assess the completeness, timeliness, and quality of outpatient care.

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