Sergei Sobyanin: Heart attack treatment in Moscow meets the world’s highest standards

Sergei Sobyanin: Heart attack treatment in Moscow meets the world’s highest standards
Photo: Photo by the Mayor and Moscow Government Press Service. Denis Grishkin
The death rate from cardiovascular diseases has been reduced, thanks to modernised emergency medical services, new vascular centres and the latest treatment methods, as well as high-tech equipment and advanced training for medical staff.

Sergei Sobyanin has visited the atherothrombosis centre in the Davydovsky municipal clinical hospital, one of Moscow’s best research and practical centres for cardiovascular diseases.

The Mayor said medical care for patients suffering from myocardial infarction in Moscow hospitals conforms to the world’s highest standards. “I have come to thank you for your hard work to save the patients, including those who have suffered a myocardial infarction,” he said. “Indeed, Moscow has seen a complete transformation in this area in the past few years.”

The Mayor added that the situation was totally different only a few years ago. “Unfortunately, almost one in four patients did not survive, even those who were brought to our hospitals,” he said. “But now the situation has drastically improved, owing to the work of ambulance teams that now arrive faster, are more accurate in their diagnosis, and are capable of providing first aid and transporting the patient to a relevant clinic in the shortest possible time.”

Mr Sobyanin said that the progress was also due the unique equipment that Moscow hospitals have received, including the cardiovascular centre of the Davydovsky Hospital. All major Moscow clinics now have such centres, which provide assistance to thousands of people.

“Thanks to your professionalism, skills, and the system currently functioning in Moscow, medical care for heart attack patients now meets the highest European standards,” Mr Sobyanin said. “This is, of course, a true achievement for Moscow healthcare.”

During his visit to the hospital, the Mayor distributed letters of appreciation and certificates to the cardiologists who had taken an active part in developing the modern and efficient system of treatment for acute myocardial infarction patients.

One of the award recipients was Professor and Doctor of Medical Sciences Alexander Shpektor, head of the university cardiology clinic. “Dr Shpektor is helping us to design a new system for treating strokes similar to the one we have established for heart attacks,” Mr Sobyanin said. “The first patients have already been treated with a unique operation, using unique instruments. So hopefully Moscow will soon have another network, the best in Russia, providing medical aid to patients who find themselves in this situation.”

Letters of appreciation were also given to:

  • Professor and Doctor of Medical Sciences, Deputy Chief Doctor for medical treatment Anastasia Lebedeva;
  • Candidate of Medical Sciences, Head of the X-ray and endovascular diagnostics and treatment methods department Dmitry Skrypnik;
  • Cardiologist and Candidate of Medical Sciences Anna Kalinskaya;
  • Cardiologist and Candidate of Medical Sciences Nadezhda Ryazankina;
  • Cardiologist and Head of the cardiology organisation and methods department, Candidate of Medical Sciences Anna Sapina.

The Davydovsky municipal clinical hospital (also known as Yauzskaya) was founded in 1866 and is one of Moscow’s oldest in-patient clinics. The hospital occupies the former family estate of the Batashev family, designed by Architect Osip Zhilyardi, a fine example of the Russian classicism of the 18–19th centuries.

In Soviet times, the hospital was named Medsantrud #23 and was only recently renamed after renowned autopsist Ippolit Davydovsky (1887–1968).

Currently, the hospital has 507 beds, including 30 beds in emergency care and 15 in the daytime in-patient department. Last year alone, over 20,000 people received medical treatment in the hospital, with 85 percent of them admitted in a critical condition. A total of 799 patients received high-tech medical care. In 2015, another 440 patients were provided with high-tech medical care.

In accordance with the Moscow healthcare development plan for 2011–2016, the hospital has received 932 units of modern medical equipment, including CT and MRI scanners, two angiographs, digital X-ray mobile systems and more. From 2014, the hospital buildings have been under thorough repair.

The new intensive treatment methods have reduced patients’ average stay in the hospital from 9.7 in-patient days in 2014 to 7.8 days currently.

The hospital employs 159 doctors, including 17 doctors  and 60 candidates of medical sciences. The main medical services include GP consultations, cardiology, pulmonology, neurology (for patients with serious cerebral blood circulation disorders), surgery (including purulent and chest surgery) and gynaecology.

The hospital also has: 

  • an atherothrombosis centre and a university cardiology clinic of the Yevdokimov Moscow State University of Medicine and Dentistry;
  • a centre for personalised medicine set up to introduce modern highly efficient methods of complex treatment for patients with somatic pathology, using personalised medicines and non-surgical programmes;
  • a centre for osteomyelitis;
  • a centre for purulent chest surgery;
  • a department of general surgery of the Sechenov 1st Moscow State Medical University.

Heart clinic

An important division of the Davydovsky Municipal Clinical Hospital is an atherothrombosis centre, which includes:

  • A cardiac intensive care unit;
  • An endovascular diagnostics and treatment unit;
  • A cardiology unit for patients with acute myocardial infarction (primary vascular unit);
  • A unit for patients suffering from acute cerebral circulation disorder;
  • A special lab of atherothrombosis.

The centre was one of the first in Moscow to operate as a university clinic in collaboration with the department of cardiology of the Yevdokimov Moscow State University of Medicine and Dentistry (headed by Prof. Shpektor) and the world’s leading atherosclerosis centres.

Modern equipment and highly qualified staff allow the centre to carry out all types of modern surgeries on heart and blood vessels, including:

- Coronary revascularisation with angioplasty combined with stenting for coronary heart disease;
- Cardiac resynchronisation pacing;
- Endovascular destruction of accessory pathways and arrhythmogenic heart zones;
- Implantation of two- and three-chambered pacemakers with frequency adaptation;
- Surgery and/or cryodestruction of accessory pathways and arrhythmogenic heart zones;
- Implantation of one-, two- and three-chambered cardioverter defibrillators.

Last year, the centre received over 4,000 patients, including 543 suffering from acute myocardial infarction. The mortality rate for acute infarction was only seven percent.

The organisation of cardiac intensive care unit and angiography unit served as a model to create a system of providing aid to heart attack patients throughout the city.

In addition to treatment, the experts carry out extensive research and help doctors to improve their skills. The centre is also a clinical base for qualification examinations and certification of cardiologists. Over the past five years, 1,029 specialists have undergone training here.

In 2013, the university clinic staff won a contest for a Russian Government mega grant for creating and developing a special atherothrombosis lab. An external leading scientist of the lab is renowned Russian and US virologist, Doctor of Science (Biology), Prof. Leonid Margolis, Chief of the Section of Intercellular Interactions at the NIH (USA) and Deputy Director of the NIH Three-Dimensional Tissue Culture Centre. Over five years, he has delivered lectures and seminars for students and teaching staff at the Yevdokimov Moscow State University of Medicine and Dentistry, and the NIH lab staff undergoes annual training at the Moscow atherothrombosis lab.

The lab mainly studies the role of immune and viral mechanisms of atherosclerosis biology. Unique equipment allows for research at the cellular, vesicular, molecular and genetic levels. The scientists use:

- a flow cytometer of the latest generation, BD FACS Aria II, to carry out multicolour flow cytometry and sorting of particles to detect nanoparticles with a size of 100 nanometres – extracellular vesicles;

- a system for the digital amplification of nucleic acids, BioRad QX200, allowing to detect single nucleic acids within to the accuracy of one copy;

- a Nanosight LM10 nanoparticle size and concentration analyser.

Studies of atherosclerosis are of great practical importance, as a deep understanding of the causes and factors of disease development will allow for more successful prevention and treatment in early stages, before the occurrence of the most severe complications: a heart attack or a stroke.

Thousands of lives saved: Latest treatment methods and modernisation of emergency aid

Improving care for patients suffering from cardiovascular diseases is a priority for the Moscow healthcare programme. Since 2011, most attention has been paid to the modernisation of the system of emergency and routine care for patients suffering from myocardial infarction or who at risk for it.

Modernisation of emergency aid

Thanks to the introduction of modern equipment and information systems, the average wait time for a response when calling 03 was reduced from 45 seconds to in 2010 to 11 seconds today.

The distribution of ambulance stations, equipping vehicles with the GLONASS system, improved dispatching, creating dedicated lanes for public transport and the reduction of traffic congestion reduced the average time between a call and the delivery of a patient to hospital to 90 minutes.

Care for heart attack patients starts in the intensive care ambulance.

Establishing vascular disease centres

Vascular disease centres were established in 29 municipal hospitals to provide emergency and routine care to patients suffering from a heart attack, stroke and acute coronary syndrome. Twenty-four of these centres focus on treating acute myocardial infarction, constituting the so called infarction network.

Vascular disease centres are equipped with modern equipment, including 35 angiographs.

The carried out repair also helps patients recover more quickly.

Modern treatment methods and raising MHI tariffs

Since 2011, the Moscow City MHI Foundation has repeatedly raised tariffs for inpatient treatment of patients with cardiovascular diseases. This increased the volume of services provided and compensated the rising cost of imported supplies due to devaluation of the rouble.

Also, the number of quotas for high tech cardiology treatment (cardiology category) has increased. The number of patients who have received this kind of aid increased by five times: from 6,420 people in 2010 to 31,742 people in 2016.

The share of vascular stenting surgeries for relevant patients increased from 30 to 87.5 percent.

Secondary prevention

Last year, city clinics opened units for the secondary prevention of myocardial infarction and cardioembolic strokes.

As a result of modernising the system of emergency and routine care for heart attack patients, the mortality rate has decreased almost three times from 2012 to 2016. Almost 92 percent of heart attack patients receive successful treatment, which meets the best world standards. 

This year, Moscow launched a programme to improve care for stroke patients based on the experience of establishing the infarction network. Relevant treatment is provided at the Sklifosovsky National Research Institute of Emergency Care, the Botkin Clinical Hospital, Pirogov Clinical Hospital No. 1, the Buyanov Clinical Hospital, Filatov Clinical Hospital No. 15, the Davydovsky Clinical Hospital, Clinical Hospital No. 31 and the Veresayev Clinical Hospital.