[Decompensation of Heart Failure in "Fragile" Patients: Clinical Features and Approaches to Therapy].

IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Kardiologiya Pub Date : 2024-02-29 DOI:10.18087/cardio.2024.2.n2554
A A Senichkina, N M Savina, N V Lomakin
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Abstract

Aim: To evaluate the impact of frailty syndrome (FS) on the course of acute decompensated heart failure (ADHF) and the quality of drug therapy before discharge from the hospital in patients with reduced and moderately reduced left ventricular ejection fraction (LVEF).

Material and methods: This open prospective study included 101 patients older than 75 years with reduced and mid-range LVEF hospitalized for decompensated chronic heart failure (CHF). FS was detected during the outpatient follow-up and identified using the Age is Not a Hindrance questionnaire, the chair rise test, and the One Leg Test. The "fragile" group consisted of 54 patients and the group without FS included 47 patients. Clinical characteristics of patients were compared, and the prescribing rate of the main drugs for the treatment of CHF was assessed upon admission to the hospital. The sacubitril/valsartan or dapagliflozin therapy was initiated in the hospital; prescribing rate of the quadruple therapy was assessed upon discharge from the hospital. Patients with reduced LVEF were followed up for 30 days, and LVEF was re-evaluated to reveal possible improvement due to optimization of therapy during hospitalization. Statistical analysis was performed with the SPSS 23.0 software.

Results: The main causes for decompensation did not differ in patients of the compared groups. According to the correlation analysis, FS was associated with anemia (r=0.154; p=0.035), heart rate ≥90 bpm (r=0.185; p=0.020), shortness of breath at rest (r =0.224; p=0.002), moist rales in the lungs (r=0.153; p=0.036), ascites (r=0.223; p=0.002), increased levels of the N-terminal pro-brain natriuretic peptide (NT-proBNP) (r= 0.316; p<0.001), hemoglobin concentration <120 g / l (r=0.183; p=0.012), and total protein <65 g / l (r=0.153; p=0.035) as measured by lab blood tests. Among patients with LVEF ≤40 % in the FS group (n=33) and without FS (n=33), the quadruple therapy was a part of the treatment regimen at discharge from the hospital in 27.3 and 3.0 % of patients, respectively (p=0.006). According to the 30-day follow-up data, improvement of LVEF was detected in 18.2% of patients with LVEF ≤40% in the FS group and 12.1% of patients with LVEF ≤40% in the FS-free group (p=0.020). In patients with LVEF 41-49 % in the FS (n=21) and FS-free (n=14) groups, the prescribing rate of the optimal therapy, including sacubitril/valsartan, sodium-glucose cotransporter 2 inhibitors, beta-blockers, and mineralocorticoid receptor antagonists, no statistically significant differences were detected (14.3 and 7.1 %, respectively; p=0.515) at discharge from the hospital.

Conclusion: Patients with ADHF and FS showed more pronounced clinical manifestations of decompensation, anemia, heart rate ≥90 beats/min, and higher levels of NT-proBNP upon admission. The inpatient therapy with sacubitril/valsartan or dapagliflozin was more intensively initiated in FS patients with reduced LVEF. An individualized approach contributed to achieving a prescribing rate of sacubitril/valsartan of 39.4%, dapagliflozin of 39.4%, and quadruple therapy of 27.3% upon discharge from the hospital.

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["脆弱 "患者的心衰失代偿:临床特征和治疗方法]。
目的:评估虚弱综合征(FS)对左心室射血分数(LVEF)降低和中度降低的急性失代偿性心力衰竭(ADHF)病程和出院前药物治疗质量的影响:这项开放性前瞻性研究纳入了101名因慢性心力衰竭(CHF)失代偿住院的75岁以上左室射血分数降低和中度降低的患者。FS是在门诊随访期间发现的,并通过年龄不是障碍问卷、椅子起立测试和单腿测试进行鉴定。脆弱 "组有 54 名患者,无 FS 组有 47 名患者。比较了患者的临床特征,并评估了入院时治疗慢性心力衰竭的主要药物的处方率。在医院开始使用沙库比特利/缬沙坦或达帕利嗪治疗;出院时评估四联疗法的处方率。对 LVEF 下降的患者随访 30 天,并重新评估 LVEF,以揭示住院期间优化治疗可能带来的改善。统计分析使用 SPSS 23.0 软件进行:结果:两组患者失代偿的主要原因没有差异。根据相关性分析,FS 与贫血(r=0.154;p=0.035)、心率≥90 bpm(r=0.185;p=0.020)、休息时气短(r=0.224;p=0.002)、肺部湿啰音(r=0.153;p=0.036)、腹水(r=0.223;p=0.002)、血液化验室检测的N末端前脑钠尿肽(NT-proBNP)水平升高(r= 0.316; p<0.001)、血红蛋白浓度<120 g / l(r=0.183; p=0.012)和总蛋白<65 g / l(r=0.153; p=0.035)。在LVEF≤40%的FS组(33人)和非FS组(33人)患者中,分别有27.3%和3.0%的患者在出院时将四联疗法作为治疗方案的一部分(P=0.006)。根据 30 天的随访数据,在 FS 组 LVEF ≤40% 的患者中,18.2% 的患者 LVEF 有所改善,在无 FS 组 LVEF ≤40% 的患者中,12.1% 的患者 LVEF 有所改善(P=0.020)。在LVEF为41-49%的FS组(21人)和无FS组(14人)患者中,出院时最佳疗法的处方率,包括沙库比曲利/缬沙坦、钠-葡萄糖共转运体2抑制剂、β受体阻滞剂和矿化皮质激素受体拮抗剂,未发现有显著统计学差异(分别为14.3%和7.1%;P=0.515):结论:ADHF 和 FS 患者入院时表现出更明显的失代偿、贫血、心率≥90 次/分和更高的 NT-proBNP 水平。在 LVEF 降低的 FS 患者中,住院治疗中更多地使用了沙库比特利/缬沙坦或达帕格列净。个体化治疗方法使萨库比特利/缬沙坦的处方率达到39.4%,达帕格列净的处方率达到39.4%,出院时四联疗法的处方率达到27.3%。
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来源期刊
Kardiologiya
Kardiologiya 医学-心血管系统
CiteScore
1.70
自引率
20.00%
发文量
94
审稿时长
3-8 weeks
期刊介绍: “Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology. As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields. The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords). “Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus. The Journal''s primary objectives Contribute to raising the professional level of medical researchers, physicians and academic teachers. Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums; Further improve the general quality of reviewing and editing of manuscripts submitted for publication; Provide the widest possible dissemination of the published articles, among the global scientific community; Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.
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