Russians with atrial fibrillation will receive free medicines

Patients with atrial fibrillation, or atrial fibrillation, will begin to receive preferential drug coverage for the first time. The Ministry of Health published the corresponding draft document for public discussion. For now we are talking only about those patients whose condition can be described as severe heart failure. Medical experts from the Higher School of Economics (HSE) previously indicated that the spread of atrial fibrillation has reached epidemic proportions—by 2036, the number of patients with this diagnosis in Russia could exceed 3 million. This disease accounts for more than 35% of all deaths among Russian men of working age.

On the portal of regulatory legal acts, the Russian Ministry of Health published a draft of a new edition of the state program “Health Development”. The document also regulates preferential treatment for patients with cardiovascular diseases. For the first time, it is proposed to include patients with coronary heart disease who have atrial fibrillation in the categories requiring state support, and a left ventricular ejection fraction value of ≥40% should be recorded within the last 12 months using an ECG. Cardiologist of the Doctis telemedicine service Muraz Shambatov explained that we are talking about a fairly severe category of patients: an ejection fraction below 40% suggests severe heart failure.

The changes will affect Appendix No. 8 of the state program. If the draft is adopted, the new rules will come into force in January 2024.

Atrial fibrillation, also known as atrial fibrillation, is a disease associated with irregular heart rhythm. Normally, the heart contracts at a frequency of 60 to 80 beats per minute, and contractions are performed alternately first by the atria and then by the ventricles. With atrial fibrillation, the atrial muscles stop functioning simultaneously and contract in a chaotic manner, which causes irregular contraction of the ventricles. All this interferes with the normal functioning of the heart. Atrial fibrillation is primarily an age-related disease.

“Kommersant” talked about a large-scale study by HSE experts on the impact of atrial fibrillation on the macroeconomics of Russia (see “Kommersant” dated October 2). According to their calculations, by 2036 the number of such patients could exceed 3 million – this is 601 thousand more than in 2019. The damage to the economy from it will range from 962.1 billion to 1566.6 billion rubles, increasing by 1.7–1.8 times compared to 2019. The study authors noted that the development of atrial fibrillation especially affects the loss of working years among Russian men: this disease accounts for more than 35% of all deaths among them. Thus, the total losses caused by atrial fibrillation in 2019 amounted to 1,174,135.6 years. Of these, 864,552 were caused by associated diseases (ischemic stroke and myocardial infarction). The latter lead to a significant portion of deaths associated with arrhythmia.

During the period of demographic aging of the population, atrial fibrillation has reached epidemic proportions, HSE experts pointed out. At the same time, unlike other cardiac diseases, it has received “surprisingly” little attention from Russian health authorities. Thus, in the federal project “Combating Cardiovascular Diseases” there is no special program to combat the development of arrhythmias. There are not even separate statistical records on the epidemiology of this disease. There are no registers of patients suffering from cardiac arrhythmias, who complained to the HSE.

The head of the research group, director of the Institute of Health Economics at the Higher School of Economics, Larisa Popovich, does not see in the decision on preferential treatment for patients with atrial fibrillation “the possibility of completely solving the problem”: “We are talking only about subsidies for medicines, but these patients often require surgical interventions, about increasing subsidies for which I don’t see anything in the document yet.” According to her, the problem of fibrillation requires closer attention and, “perhaps, a more focused consideration than just a double mention, and only in combination with coronary heart disease”: “Separately, fibrillation is no less terrible as a risk factor for many deaths, therefore it deserves an independent program struggle.”

Cardiologist Muraz Shambatov confirms that patients with atrial fibrillation urgently need modern anticoagulant therapy (promotes slower blood clotting and prevents the formation of blood clots). “Unfortunately, most of these anticoagulants are unaffordable for patients, and such an initiative on the part of the state can only be welcomed,” says Mr. Shambatov. “Preferential provision will allow in most cases to switch to modern anticoagulants and eliminate the use of warfarin, which has a number of problems in use ” Warfarin is an indirect anticoagulant, an “old drug” that requires regular monitoring of blood tests to assess its effectiveness and safety for an individual patient. If patients receive preferential treatment with alternative drugs to warfarin, their quality of life and prognosis will significantly improve, the cardiologist believes.

Natalia Kostarnova