| Objective To analysis the aetiology, clinical characteristics, drug therapies, results of therapy of hospitalized patients with chronic heart failure in late 20 years in the first central hospital in Tianjin, and review the trend of variables above as time went by. A conclusion could be made about clinical characteristics, diagnosis and treatment of hospitalized cases with chronic heart failure. More information of prevention and treatment strategy would be provided. At the same time, precious data was collected for the more large-scale epidemiology survey in Tianjin city in future days.Methods 1259 hospitalized cases with chronic heart failure which was the primary diagnosis at discharge were collected in the late 20 years(from January 1st, 1983 to December 31st,2002) in the first central hospital of Tianjin. More variables including general items, aetiology, concomitant diseases, complications, X-ray chest radiogram, echocardiogram, drug therapies, results of therapies and prognosis were recorded in detail. A retrospective analysis was performed. Results (1) Mean age was higher in the latter decade (61.31±12.69 vs66.05±11.52; P O.0001). Among them, the number of older cases (whose age was over 65 years old) were significantly increased in the latter decade(45.55%vs61.53%; x~2=23.49; P<0.0001). The sex proportion had no significant difference between two groups(x~2=1.26; P=0.2608). Mean inhospital duration was shorter in the latter decade(31.92±25.01vsl5.75±12.03; P<0.0001). Duration of illness was shorter in the latter decade(z=-7.40; P<0.0001). The number of cases with NYHAII increased in the latter decade(x~2=7.40; P=0.005), but no significant difference was seen in those with NYHAIII or NYHAIV. (2)The main aetiology of hospitalized cases with chronic heart failure in late 20 years generally included coronary artery disease (CAD), rheumatic heart disease (RHD), pulmonary heart disease (PHD), which accounted for 56.63%, 20.89%, 9.21%, respectively. The composing proportion of CAD and dilated cardiomyopathy (DCM) increased in the latter decade, while that of RHD, pulmonary heart disease (PHD), congenital heart disease (CHD) decreased in the latter decade. The composing proportion of primary aetiology between two decades was different significantly (PO.0001). The rate of the co-concomitant disease was essential hypertension (EHT, 44.00%), diabetes mellitus (DM, 16.36%), chronic obstructive pulmonary disease (COPD, 14.30%), cerebral-vascular disease (CVD, 11.36%) and anemia (5.16%) in turn. All these diseases except COPD increased during the latter decade (P<0.01). The rate of single-aetiology was predominant during the former decade, while the rate of multiple aetiology was predominant during the latter decade (PO.0001). The combination of double-aetiology most commonly seen was CAD complicated with EHT (33.84%), and the combination of the triplex-aetiology most commonly seen was CAD complicated with EHT and DM (8.26%). RHD was the main aetiology in pre-senile group(<59years), which accounted for 41.79%, while CAD was the main aetiology in old group(60-79years) and very old group(>80years), which accounted for 65.33%, 87.88%, respectively. DCM and CHD were more common aetiology in pre-senile group, while non-rheumatic valvar disease was more commonly seen in very old group. The rate of EHT, CVD and anemia increased as age increased. The rate of single- aetiology was predominant in pre-senile group, while the rate of double-aetiology was predominant in old group and very old group. (3) The number of positive history of myocardial infarction increased significantly in the latter decade(16.10%vs23.47%; /=7.17; P=0.0074), so did the number of cases with non-myocardial infarction (j￡2=44.89; PO.0001). According to bivariatelogistic regression analysis, cases who caused by CAD with old age, non-myocardial infarction history, cardiac function (NYHA class III) less probably occurred LVEF 0.40 (OR equals to 0.971, 0.528, 0.390, 0.454; respectively), while cases with longer illness duration, cardiac aneurysm, abnormity of chest X-ray radiograph, enlargement of cardiac cavity) more probably occurred LVEF 0.40 (OR equals to 1.004, 4.084, 1.332, 27.020, respectively). (4) Atrial fibrillation (AF) was the most common arrhythmia in the general cases with heart failure, which added up to 37.97%, and more commonly seen in females. The rate of female cases complicated with atrial fibrillation decreased gradually with the increase of age. The rate of cases complicated with atrial fibrillation increased gradually as time went by. (5) Infection was the most common inducement factor in the general cases, which accounted for 28.35%. Disturbance of the electrolytes was the most common complication. Hyponatremia was the most commonly seen in the general cases, which add up to 24.36%. The rate of renal dysfunction accounted for 12.71%. (6) There was no difference in the check rate of X-ray chest radiograph between the two decades (64.73%vs59.50%, /=2.91 ; P=0.087). The usage rate of echocardiogram increased significantly in the latter decade (41.44%vs74.87%, ^=113.58; P<0.000l). The cardio-thorax ratio was weakly reversely relative with left ventricular ejection fraction (LVEF) according to bivariate correlate analysis (r=-0.2142; P=0.0005). (7) The drug therapies of chronic heart failure prevailed in traditional medications including diuretics, nitrite and digitalis. The usage rate of digitalis, diuretics and calcium channel blockers (CCB) decreased as time went by, while that of beta-blockers, angiotensin-converting-enzyme-inhibitors (ACEI) and angiotensin receptor blockers (ARB) increased gradually. The general effective rate of the drug therapy was 89.44%. Compared with the former decade, the effective rate of the drug therapy in the latter decade was better(82.53%vs91.52%, ^=19.17; PO.0001). (8) The composing proportion of the aetiology of dead cases was in accord with that of the all cases with chronic heart failure. CAD, RHD and PHD were the main aetiology of dead cases, which accounted for 36.96%, 29.35%, 21.74%; respectively. The inhospital-case fatality rate of the general cases with chronic heart failure was 7.31%. Compared with that of the former decade, the inhospital-case fatality rate decreased significantly (15.57%vs4.76%, ^=40.04; PO.0001). The mode of death included aggravated heart failure (41.30%), sudden cardiac death (16.30%) and other causes (42.40%) in turn. (9) The number of cases with chronic heart failure increased significantly in the latter decade (11.26% vsl3.41%; /=7.97; JP=0.0045). But the ratio of dead cases with chronic heart failure to dead cases with all causes in cardiologic department was no significant difference between two groups (21,60%vs23.59%, /=40.04; PO.0001).Conclusions CAD, RHD and PHD were the most underlying aetiology in general cases with chronic heart failure in late 20 years. The aetiology spectrum of the hospitalized cases with chronic heart failure changed markedly. CAD was the main aetiology during the two decades. RHD and PHD decreased as time went by, DCM increased gradually as time went by. EHT, DM, COPD and anemia were the most common co-concomitant diseases. The combination of double-aetiology most commonly seen was CAD complicated with EHT. The combination of triplex-aetiology most commonly seen was CAD complicated with EHTand DM. The factor of age was the notable characteristics of cases with chronic heart failure. The primary aetiology of cases with chronic heart failure in three age-based groups was diferrent significantly. All co-concomitant diseases except COPD increased markedly with the age. Cases with the situation caused by CAD including older ages, females, lower cardiac function, history of non-myocardial infarction, had less chance to develop chronic systolic heart failure; while cases... |
PDF Full Text Request