Three - Year Prognosis, Treatment Status And Prognostic Risk Factors Of Emergency Heart Failure In Beijing Area

Background:Heart failure (HF) is the serious and terminal stage of various heart diseases, and it has the characteristics of high incidence, high rehospitalization rate and high mortality, is an important cause of death among the elderly patients with chronic diseases. Patients with heart failure in our country are numerous, but there is no domestic large register study on heart failure patients in ER, research on the long-term prognosis and treatment status in patients with heart failure is rare.Objective:To observe the current treatment and prognosis of heart failure patients in our nation, compare the difference of end points rates between HFrEF patients and HFpEF patients. To analysis the impact of (3 receptor blocker, angiotensin converting enzyme inhibitor/angiotensin receptor blocker and mineralocorticoid receptor antagonist administration on both primary and secondary endpoints, and to explore the risk factors affecting the prognosis of patients with heart failure in Beijing.Methods:As for each patients included in Beijing Acute Heart Failure Registry, we continuously followed up for three years, and collected the information of all-cause death, cardiovascular events and HF rehospitalization, as well as the treatment methods. We summarized the endpoints occurrence and treatment status, then analysis these data. According to LVEF, patients were divided into the HFpEF group and HFrEF group, and according to the history of heart failure, patients are divided into new-onset AHF group and chronic HF deterioration group.Results:1. The study included 3335 patients, with an average age of 67.4±15.8 years old, male (53.2%), was followed up until the 1080th day after registration, the overall follow-up deadline is October 30,2015,3 years loss of follow-up rate was 15.26%.2. Among the whole population,3-year all-cause mortality rate were 47.22%,3-year incidence of cardiovascular events was 61.08% and 3-years HF rehospitalization rate was 51.63%. Among groups, chronic HF deterioration group’s all-cause mortality rate, cardiovascular events rate and HF rehospitalization rate is higher than new-onset AHF group(49.52% vs 44.93%,61.94% vs 60.22%,53.18% vs 50.09%, P<0.05). While HFrEF group and HFpEF group have similar all-cause mortality rate and cardiovascular events rate (41.98% vs 41.55%,62.50% vs 60.96%, P>0.05), HFrEF group’s HF rehospitalization rates is slightly higher than HFpEF group (55.44% vs 51.30%, P=0.042).3. The administration rate of neurohumoral blockers-beta blocker, ACEI/ARB and MRA was respectively 50.9% and 40.8% and 45.9%, HFrEF group utility ratio is significantly higher than HFpEF patients. Application of neurohumoral blockers can significantly reduce 3-year all-cause mortality rate, cardiovascular events rate and HF rehospitalization rate in heart failure patients, and furthermore, patients who received all three kinds of neurohumoral blockers have the best prognosis (3-years all-cause mortality rate was 29.8%,3-year cardiovascular events rate was 61.1% and 3-year heart failure rehospitalization rate 38.3%), while patients who never used those drugs have the worst prognosis (3-years all-cause mortality rate was 66.9%,3-year cardiovascular events rate was 63.8% and 3-year heart failure rehospitalization rate 52.3%).4. Multivariable regression analysis suggest the risk factors of 3-years all-cause mortality among Beijing AHF patients include age, higher NYHA classification, lower BMI, reduced SBP and increased heart rate.Conclusion:The long-term prognosis in Beijing AHF patients is still poor. Although there is a major difference of clinical characteristics between HFrEF patients and HFpEF patients, their long-term prognosis are similar. Compared with new-onset AHF patients, chronic HF deterioration patients have poorer prognosis. Neurohumoral blocking drugs (including beta-blockers, ACEI/ARB and MRA) application presents significant correlation with the improvement of prognosis, and application three kinds of neurohumoral block drugs at the same time can further improve prognosis. However, in the Beijing AHF population, long-term treatment status is not satisfactory, utilize rate of neurohumoral blockers is still low. Multivariable regression analysis suggest the risk factors of 3-years all-cause mortality among Beijing AHF patients include age, higher NYHA classification, lower BMI, reduced SBP and increased heart rate, has certain guiding significance on clinical judgment of those patients at risk.