Opportune and early detection of the patients with risk factors of cardiovascular diseases (CVD), particularly coronary heart disease (CHD), elimination of their influence and the further monitoring of the risk group patients belong to the main tasks of family medicine doctor. Risk assessment tools estimating absolute coronary or cardiovascular risk are used to identify high-risk people for primary prevention. However, according to many scientists the existing risk measurement systems have fundamental limitations. The risk assessment charts don't allow evaluating the changes of the risks after the correction of some modified factors such as total cholesterol, arterial pressure, smoking cessation etc. There are no schemes of changes of the tactics of treatment and prevention depending on the dynamics of the pathological process, changes of the single risks and the total assessment of patient's condition. In addition, risk calculation is usually based on the restricted number of factors, while limited attention is paid to other factors that have an impact on the cardiovascular system (physical activity, food habits etc.) The objective of the work was to create and evaluate the effectiveness of the system of referred questioning, risk management and monitoring of the condition of the patient with risk factors of coronary heart disease for the optimization of family doctor practice. We examined 948 patients that had been divided into four groups. General clinical investigation, extended laboratory diagnostics (general blood analysis, cholesterol panel, fibrinogen), ECG, ergometry, transtoracal echocardiography, Holter monitoring, ambulatory monitoring of arterial pressure were performed to the patients (clinical examination, ECG, Holter monitoring and ambulatory monitoring of arterial pressure were done by the author). Methodology of the investigation was based on the conception of risk assessment, risk management and also clinical monitoring. Conception of risk assessment was considered to be the main mechanism of optimization of management of patients with CHD. Clinical monitoring is a system of attendance, analysis, assessment and prognosis of the patient's condition. This system gives an opportunity not only to manage risks, but also to receive information about the real influence of risk factors on health. Risk management (RM) is a logical continuation of risk assessment and is referred to validate optimal solutions for its elimination or minimization, and also monitoring of exposition and risks. We offer the system of assessment of risk factors in dynamics depending on the condition of the patient that allow in 93% of the cases predict onset of the CHD in patients with risk factors of CHD and the clinical worsening of the CHD in patients with verified CHD. For the analysis of risk factors we have designed the questionnaire for the early detection of risk factors of CHD and metabolic changes. It allows revealing of CHD in 70% of cases. We proved the assessments and monitoring technologies of individual risk of CHD in patients with peculiarities of lifestyle, metabolic disorders and hereditary factors. We showed that they allow in 85.1±1.6% of the cases to determine the prognosis and identify the risk of CHD. We validated the statistical models of pre-clinical flow of CHD and for the first time identified three types of dynamics of CHD in patients with risk factors: stable, unstable, progressive. We suggested using the concept of integrated risk assessment and danger identification as the main mechanism of optimization of tactics of management of patients with risk factors of coronary heart disease. Such methodology would allow using of personally-oriented system of preventive measures. We proved the efficiency of the telemedicine consultation for family doctors on the basis of latest information technology in the modern system of clinical examination of patients with CHD.
