Chronic Heart Failure in Patients Hospitalized in 2002 and 2021: Comparative Analysis of Prevalence, Clinical Course and Drug Therapy

AIM

Comparative analysis of the prevalence of chronic heart failure (CHF), clinical and medical history data, and drug therapy of patients admitted to a cardiology hospital in 2002 and 2021.

MATERIAL AND METHODS

The study analyzed the medical records of patients with a confirmed diagnosis of CHF who were admitted in 2002 (n=210) and 2021 (n=381) to a specialized cardiology hospital.

RESULTS

According to medical records of 2021, the proportion of patients with a confirmed diagnosis of CHF (87.6%) in the cohort of patients admitted to a cardiology hospital was twice as high as in 2002 (46.4%; p<0.001). The majority of patients with CHF in the study sample were patients with preserved left ventricular ejection fraction (HFpEF). The proportion of such patients significantly increased to reach 75.9% in 2021 compared to 58.6% in 2002 (p<0.001). At the same time, the number of severe forms of CHF (NYHA functional class (FC) IV) decreased by 10% and was 13.2% in 2002 and 1.3% in 2021 (p<0.001). In the majority of patients, ischemic heart disease (98.1 and 91.1% in 2002 and 2021, respectively, p<0.001) and hypertension (80.5 and 98.2%, respectively, p<0.001) were diagnosed as the cause for CHF. Furthermore, the incidence of comorbidity increased significantly: atrial fibrillation was detected in 12.3% of patients in 2002 and 26.4% in 2021 (p < 0.001); type 2 diabetes mellitus, in 14.3 and 32% of patients (p <0.001); and obesity, in 33.3 and 43.7% of patients, respectively (p=0.018). The frequency of using the major groups of drugs increased during the analyzed period: renin-angiotensin-aldosterone system blockers were administered to 71.9% of patients in 2002 and to 87.7% in 2021 (p<0.001); beta-blockers were administered to 53.3 and 82.4% of patients (p<0.001); and mineralocorticoid receptor antagonists, to 1.9 and 18.6% of patients, respectively (p=0.004).

CONCLUSION

In 2021, the proportion of patients with a confirmed diagnosis of CHF in the patient cohort admitted to a cardiology hospital was twice as high as in 2002; the phenotype with preserved left ventricular ejection fraction predominated in the CHF structure. During the analyzed twenty-year period, the prevalence of comorbidities increased among CHF patients. The prescription frequency of pathogenetic evidence-based therapy has significantly increased by 2021, however, it remains insufficient even in patients with CHF with reduced left ventricular ejection fraction.

[Biomarkers of Inflammation in Predicting the Outcomes of Heart Failure of Ischemic Etiology: the Results of Factor Analysis]

AIM

To study the prognostic significance of inflammatory biomarkers in patients with chronic heart failure (CHF) and stenotic multivessel coronary atherosclerosis, with determination of the biomarker separate set that reflects subclinical inflammation and is associated with the development of cardiovascular complications during prospective observation.

MATERIAL AND METHODS

A prospective observational study was conducted that included 80 patients with CHF and ischemic heart disease who were scheduled for coronary artery bypass grafting (CABG) during their current hospitalization. In addition to routine clinical laboratory tests, coagulation parameters were evaluated and the following inflammatory biomarkers were determined: neutrophil gelatinase-associated lipocalin (NGAL), growth/differentiation factor 15 (GDF-15), fibroblast growth factor 23 (FGF-23), transforming growth factor beta-1 (TGF-β1), and high-sensitivity C-reactive protein. Also, the calculated neutrophil-to-lymphocyte ratio (N LR) was included in the analysis. Follow-up duration was at least 12 months (median 16 [13, 22] months). Statistical analysis of the data was performed with the IBM SPSS Statistics 21 software.

RESULTS

The study presented results of a factor analysis of 10 inflammatory biomarkers in patients who were scheduled for CABG. One of the factors identified by the analysis included the levels of NGAL and GDF-15, N LR, and the level of fibrinogen in the blood in CHF patients with stenotic coronary atherosclerosis and was significantly associated with the death rate during prospective observation. Furthermore, this association remained significant even after adjustments for age, glomerular filtration rate, severity of heart and coronary insufficiency, and the presence of diabetes mellitus.

CONCLUSION

In patients with CHF and stenotic coronary atherosclerosis, a set of inflammatory markers, including blood NGAL, GDF-15, N LR, and fibrinogen, can be combined into one factor reflecting subclinical inflammation. The value of this factor can be used to predict cardiovascular death in the long term after surgical myocardial revascularization.

[Iron deficiency in cardiac surgery patients and the possibility of its correction at the preoperative stage]

Among cardio-surgical patients, the prevalence of iron deficiency conditions reaches 70 %, and anemia is detected in less than 50% cases. Meanwhile, both anemia and latent iron deficiency are risk factors for adverse outcomes in cardio-surgical patients. These conditions are associated with a high frequency and greater volume of blood transfusions as well as with a longer stay in the hospital. Timely diagnosis and correction of iron deficiency, regardless of the presence of anemia, are mandatory at the stage of preoperative preparation. The use of oral iron medicines is limited by their low efficacy in this category of patients and a high risk of adverse events. Intravenous iron medicines have a high potential for correcting iron deficiency, and their efficacy and safety have been previously demonstrated. Administration of ferric carboxymaltose has proved beneficial in studies on iron deficiency correction in cardiological and cardio-surgical patients. In these patients, ferric carboxymaltose improved the dynamics of ferritin and hemoglobin, reduced the risk of blood transfusion, and decreased the duration of stay in the hospital. Preoperative intravenous administration of ferric carboxymaltose to cardio-surgical patients can improve clinical outcomes and the cost effectiveness of cardiac surgery.

[Difficulties in diagnosis of heart failure with preserved ejection fraction in clinical practice: dissonance between echocardiography, NTproBNP and H2HFPEF score]

This pilot study was aimed to assess the percentage of patients admitted to a Russian hospital and diagnosed with heart failure with preserved ejection fraction (HFpEF) maintaining this diagnosis when evaluated against the ESC 2016 and Russian 2017 heart failure guidelines. In addition, we reviewed the probability of an HFpEF diagnosis when patients were assessed against the H2FPEF score. Forty-two patients (mean age 68 ±7,5) diagnosed with HFpEF on their discharge record, admitted between March 2018 and May 2018, were included. Twenty percent of patients did not meet Russian guideline criteria for HFpEF due to either the absence of symptoms and/or echocardiographic evidence of structural/functional abnormalities. Using the ESC 2016 guidelines (which required an elevation in NT Pro BNP) the diagnosis was confirmed in only 37% of patients, mostly due to the normal level of NTproBNP in 54.8% of those investigated. The probability of HFpEF by H2FPEF score in patients with dyspnea and HFpEF by ESC 2016 criteria was 93% and without HFpEF by ESC 2016 criteria 68% (p = 0.054). In contrast, the probability of HFpEF by H2FPEF score in patients with dyspnea and HFpEF by Russian criteria was 84.4%.

[Factors for unfavorable prognosis in elderly patients with previous acute myocardial infarction. The role of the ambulatory rehabilitation stage.]

The paper presents the results of the study of the long-term post-infarction period in elderly patients with 5 years survival after myocardial infarction. The factors and features of the ambulatory rehabilitation stage that have a significant impact on the long-term post-infarction period have been established. It is shown that a regular follow up at the ambulatory rehabilitation stage along with such risk factors as the volume of coronary lesions, burdened history, complicated during the acute period of myocardial infarction have a significant impact on the post-infarction period. It was found that more than half of patients with recurrent cardiovascular events, irregularly visit or do not visit the clinic after a coronary accident. At the same time, doctor visits at the outpatient stage at less once a year increase the chances of an unfavorable course of the post-infarction period in 5,5 times (p<0,001).

[Longterm survival of elderly patients after myocardial infarction depending on management in the acute period of the disease.]

The paper presents the results of study 5-year survival of elderly patient after acute myocardial infarction. It is shown that this category of patients, used less invasive diagnostic and treatment strategy, compared with younger. In our study the effectiveness of primary percutaneous coronary intervention confirmed in patients with myocardial infarction with ST-segment elevation (STEMI) in relation to long-term survival. However, between the groups of successful thrombolytic therapy and pharmacoinvasive treatment strategy, no significant differences have been identified. This fact and the conflicting data of modern researches in this area confirm that the choice of treatment strategy of acute myocardial infarction in the elderly is challenging and requires an individual approach.

[Acute myocardial infarction in elderly and senile patients: epidemiology study according to the who program "registry of acute myocardial infarction]

The article presents results of the epidemiology study of acute myocardial infarction (AMI) among permanent Tomsk residents older than 60 years. The study was conducted in 2008-2009 according to the WHO program «Registry of Acute Myocardial Infarction». Data demonstrated that morbidity and mortality from AMI was higher in the above mentioned age group than in younger population. Rates of morbidity and mortality in men exceeded those in women in all age groups except population older than 80 years. The study showed high in-hospital lethality caused by high death rates in patients 60 years of age and older who were treated in non-specialized hospitals. Authors conclude that the severity of epidemiology situation with AMI is determined by the frequency of this pathology in population older than 60 years suggesting the necessity of change in the strategy of system development of medical care for AMI patients with focus on the older age groups.

[CAUSES OF DEATH IN PATIENTS WITH ACUTE MYOCARDIAL INFECTION IN NON-SPECIALIZED SETTINGS]

The aim of the study was to analyse the causes of death in patients with acute myocardial infection (AMI) treated in non-specialized settings of the city of Tomsk based on the WHO registry of AIM. A total of 156 deaths from AIM that occurred in 2013 were studied. The diagnoses were verified using results of autopsies. The study group included 42.3% of men and 57.7% of women. 91.7% of the deceased patients aged above 50 years including 30.4% of those above 80 years. All patients were referred to the clinics by the emergency aid services. Most of them presented with the atypical onset and clinical picture of AIM, had an aggravated medical history, and died soon after hospitalization. Results of primary medical examination suggested AIM only in 58.3% of the cases. The remaining patients showed ECG signs of possible AIM. Positive results of serum enzyme tests (creatine phosphokinase, its MB fraction, troponin) were obtained in 72.4% of the cases. It is concluded that the above death cases were very complicated diagnostically, clinically, and prognostically. To prevent lethal outcomes, all patients with unstable angina should be hospitalized only in specialized clinics providing regular ECG monitoring and control of biochemical markers of myocardial necrosis for diagnostics of suspected AIM.