The Russian Federation has 146.6 million inhabitants and the largest territory in the world. Cardiovascular mortality in the country is unacceptably high, and cardiovascular disease is the leading cause of death, accounting for ≈1 million (46%) of all fatalities per year.

During the late 20th century and early 2000s, Russia faced a profound socioeconomic crisis with a dramatic increase in cardiovascular mortality. However, from 2003 through 2019, the number of deaths attributable to circulatory disorders steadily declined by ≈3% annually, with a total decrease of 51% (Figure); in particular, deaths resulting from ischemic heart disease decreased by 45.8% and from cerebrovascular disease by 60.1%.¹

Figure. Temporal trends in age-standardized mortality rates and number of deaths resulting from cardiovascular diseases in Russia.Top, Temporal trends in age-standardized cardiovascular mortality rates for men and women in Russia, 1995 to 2019. Bottom, Absolute number of cardiovascular deaths in Russia, 2014 to 2020. Data source: Federal State Statistics Service.¹

Russia has a very heterogeneous population of different social statuses, disease patterns, dietary habits, and distribution of healthcare facilities, with large areas with sparse populations. Universal health care coverage is guaranteed by the constitution. The 3 levels of medical care for patients with cardiovascular diseases include primary, specialized outpatient, and specialized inpatient care. The financial model of health care is mixed, with 60% of expenditures being covered by public health insurance and 40% by federal and regional budgets. Patients with acute cardiovascular events and interventions are provided with free medications for 12 months.

An important improvement in control of cardiovascular risk factors, promoting a healthy lifestyle and preventing noncommunicable diseases, has been the highlight since 2008. Russia joined the World Health Organization Frame Convention on Tobacco Control. Thereafter, comprehensive smoking legislation introduced in 2013 imposed serious restrictions, including a total ban on cigarette advertising with a 21% increase in tobacco taxes and a ban on smoking in public places. In April 2021, the minimal price of ₽108 (≈$1.5) for a package of cigarettes was implemented, and the mean price of the package is currently ₽150 (≈$2.1). This led to a substantial smoking reduction at the population level. In 2020, electronic cigarettes were also covered by this legislation. Similar restrictions led to a significant decrease in alcohol consumption and alcohol-related deaths in Russia. In 2003 through 2016, the total alcohol consumption dropped by 43% (20.4 to 11.7 L per capita), specifically of strong spirits by 67% (14.7 to 4.8 L per capita) and unrecorded alcohol by 48% (6.9 to 3.6 L per capita). A limitation on trans fats content of <2% was introduced in fat and oil products in 2018.

Nationwide screening for major noncommunicable diseases was introduced in 2013. This program implements risk factor questionnaires, blood pressure and heart rate measurement, total cholesterol and glucose estimation, ECG, and Systematic Coronary Risk Evaluation risk calculation for all adults. In high-risk populations, the second stage includes diagnostic investigations and follow-up by cardiologists for certain cardiovascular diseases (15 750 certified specialists in Russia or 10.8 per 100 000 population), ≈90% of them being female.

Of note, women make up <15% of practicing cardiologists in Western countries.² Such a significant sex gap with female predominance in medical professions is seen in Russia and many ex–Union of Soviet Socialist Republics states, and not only in cardiology: >90% of endocrinologists; >92% of pediatricians, rheumatologists, and gastroenterologists; and >95% of neonatologists and clinical immunologists are women. Before the recent changes introduced in the professional standard of the cardiology specialty, permitting cardiologists to obtain additional training and certification in cardiovascular imaging, coronary, vascular, and structural interventions, and electrophysiology, cardiology was mainly a noninvasive branch of internal medicine dealing with cardiovascular disease. The situation is now changing as more male graduates select cardiology as their primary specialty, but it will take time to equalize the gap.

Government health care expenditures account for 3.5% of the Gross Domestic Product in Russia, 5% of that being allocated to cardiovascular disease. Special attention is given to acute cardiovascular care, resulting in marked improvement in access to urgent interventions, pharmaco-invasive approaches, and prehospital thrombolysis in acute coronary syndromes and cerebrovascular emergencies. The primary percutaneous coronary intervention rate increased from 8.7% (2005) to 71.3% (2013), and the median travel time to the nearest percutaneous coronary intervention facility decreased from 73 minutes (2010) to 48 minutes (2015).³ There were 161 300 acute myocardial infarctions in 2019, with an overall mortality of 36.8 per 100 000 and mean hospital mortality of 11.2% (6.4% in Moscow).

Despite unprecedented achievements in the prevention and treatment of cardiovascular disease, Russia is still facing profound challenges. An increased life expectancy from 64.8 years (2002) to 73.4 years (2019), accompanied by lower birth rates (10.1 per 1000 in 2019), has resulted in population aging with a subsequent increase in disease burden and health care costs. A high prevalence of unhealthy lifestyles, insufficient control of risk factors, and lack of primary prevention remain unmet needs. The high prevalence of obesity and arterial hypertension and growing diabetes incidence are accompanied by relatively poor blood pressure control (only 49.7% of treated patients achieve target values), with a high proportion of uncontrolled hypertension and hyperglycemia (prevalence of diabetes is 5.4%, undiagnosed in 54% and untreated in 2.9%).⁴

Russia is a member of the World Health Organization and other health-related international agencies and actively collaborates to reduce cardiovascular risk and disease burden. The Russian Society of Cardiology is an active member of the European Society of Cardiology and the World Heart Federation. The European Society of Cardiology guidelines are endorsed by the Russian Society of Cardiology and published in the flagship Russian Journal of Cardiology. The Russian Society of Cardiology works closely with the Ministry of Health on national guidelines.

The medical education system in Russia is regulated by the Ministry of Health and the Ministry of Education. Medical school graduates may enter 2-year fellowship programs in cardiology (100 public seats in 2021) and pediatric cardiology (65 public seats in 2021) in accredited hospitals. Private fellowship programs also are available. A comprehensive specialty accreditation examination is run by the Ministry of Health. Regardless of the fact that a large number of cardiologists join the medical community every year, there is still an unmet need for more professionals, especially in primary care facilities and remote regions of the country.

The new professional standard of the cardiology specialty developed in 2018 implements the best training and education practices and provides a new curriculum for young doctors and investigators entering the cardiovascular disease arena. National and international print journals remain the cornerstone source of information, being steadily replaced with electronic sources, including PubMed, podcasts, and interactive social media. Close integration between major universities and the Russian Academy of Sciences allows breakthrough biomedical research and facilitates the translation of its results into clinical settings.⁵

In conclusion, despite the great improvement in cardiovascular care in Russia in recent years, disruptive innovation rather than mere evolution is needed to achieve a sustainable cardiovascular mortality reduction and improvement of cardiovascular health. Large territories experience difficulties in providing appropriate access to cardiovascular care, especially in acute cardiovascular presentations. This is partly resolved with telemedicine and remote patient monitoring, and in 2018 Russia implemented a federal law regulating these technologies in health care. Implementation of information technologies, smart mobile devices and applications in health care, and big data analytics shall be at the core of such global cardiovascular health care transformation.

None.

Disclosures None.

https://www.ahajournals.org/journal/circ

For Sources of Funding and Disclosures, see page 588.