Clinical Characteristics Of Chronic Heart Failure Patients With Different Ejection Fraction

Objective: The purpose of this study is to understand the clinical characteristics of patients who had chronic heart failure(CHF)disease with different ejection fraction in Tianjin,and analyze the influencing factors of CHF,so as to deepen the understanding of CHF with different ejection fraction,and to further develop the control of CHF in this population.Materials and Methods:We examined data of 2173 CHF patients as NYHAⅡ-Ⅳ collected in 9 hospitals in Tianjin between March 2015 and December 2017.According to the ejection fraction,the patients were divided into: HF with reduced ejection fraction(HFr EF,LVEF < 40%),HF with mid-range ejection fraction(HFmr EF,40% ≤ LVEF < 50%)and HF with preserved ejection fraction(HFp EF,LVEF ≥ 50%).The questionnaire of treatment status of patients with chronic heart failure in Tianjin was used by medical staff.The statistical investigation includes general conditions,history of heart failure,classification of heart function,etiology and complications,echocardiography and laboratory examination,and comparison of patients with different ejection fraction by χ2 test.Rehospitalization was used as the dependent variable,and gender,age,blood pressure,past medical history,and unhealthy lifestyle habits were used as independent variables to perform univariate and multivariate logistic regression analysis to explore its influencing factors.Results: 1.Among 2173 patients with available data,42.52%(N=924)had HFr EF,36.26%(N=788)had HFmr EF,and 21.22%(N=461)had HFp EF.There were significant differences in sex,age and systolic blood pressure among the three groups(P < 0.05).There was no significant difference in diastolic blood pressure and NYHA class among the three groups(P > 0.05).Compared with patients with HFp EF,patients with HFmr EF or HFr EF had more males(62.44% vs 54.45%,P < 0.0176;64.83% vs 54.45%,P < 0.0176),lower mean age(69 vs 75,P < 0.05;70 vs 75,P <0.05),lower systolic blood pressure(130 vs 136,P < 0.05;130 vs 136,P <0.05).There was no significant difference in diastolic blood pressure and NYHA class among the three groups(P > 0.05).2.In the comparison of the past medical history of the three groups,there were statistically significant differences in the patients with coronary heart disease,dilated cardiomyopathy,arrhythmia,hypertension,renal dysfunction,pulmonary infection,cerebrovascular disease,anemia,hyperlipidemia,hypoproteinemia and malignant tumor(P < 0.05);while there was no significant difference between the three groups of the patients with hypertrophic heart disease,rheumatic heart disease,myocarditis,diabetes and thyroid dysfunction(P > 0.05).With the increase of LVEF,the proportion of coronary heart disease increased gradually(81.76% vs 87.13% vs 91.96%,P < 0.0176),while the proportion of dilated cardiomyopathy decreased gradually(9.55% vs 6.75% vs 3.04%,P < 0.0176).HFmr EF were also less likely to have arrhythmia than HFp EF(44.46% vs 53.48%,P< 0.0176).Compared with patients with HFp EF,patients with HFmr EF or HFr EF were less to have renal dysfunction(19.76% vs 27.61%,P < 0.0176;21.27% vs27.61%,P < 0.0176),pulmonary infection(28.88% vs 34.35%,P < 0.0176;27.01%vs 34.35%,P < 0.0176),cerebrovascular disease(24.97% vs 34.13%,P<0.0176;24.71% vs 34.13%,P<0.0176),hypoproteinemia(9.01% vs 25.00%,P<0.0176;9.68% vs 25.00%,P<0.0176).Patients with HFp EF were also more likely to have hypertension(65.22% vs 58.63%,P < 0.0176),hyperlipidemia(10.22% vs 5.97%,P< 0.0176)and malignant tumor(2.61% vs 0.87%,P < 0.0176)than those with HFr EF.There was significant difference in the proportion of smokers and drinkers among the three groups(P < 0.05).Compared with patients with HFp EF,patients with HFmr EF or HFr EF were more to have a history of tobacco use(38.00% vs 30.87%,P< 0.0176;39.24% vs 30.87%,P < 0.0176)and drinking(13.25% vs 7.61%,P <0.0176;11.72% vs 7.61%,P < 0.0176).3.In the comparison of the results of three groups,the differences of albumin,glutamic oxaloacetylase,glutamic pyruvic transaminase,uric acid,NT-pro BNP and RBC level were statistically significant(P <0.05),while there was no significant difference of creatinine,triglyceride,low-density lipoprotein,total cholesterol,blood sodium,potassium,blood glucose,platelet and WBC level were among the three groups(P > 0.05).With the increase of LVEF,RBC level decreased(4.40 vs 4.35 vs 4.06,P < 0.0176).Compared with patients withHFp EF,it is higher with the level of albumin,glutamic oxaloacetate transaminase and glutamic pyruvate transaminase in patients with HFmr EF or HFr EF(P < 0.05).The uric acid level of HFr EF group was higher than that of the other two groups(396 vs355,P < 0.05;396 vs 341,P < 0.05).The level of NT-pro BNP in HFmr EF group were lower than those in other two groups(2948 vs 4168,P < 0.05;2948 vs 3466,P< 0.05).4.By comparing the echocardiographic data,we found that the differences of LVEF,left ventricular end diastolic diameter and left atrial diameter were statistically significant(P < 0.05).With the increase of ejection fraction,the left atrial diameter decreased(60 vs 55 vs 49,P < 0.05).The left ventricular end diastolic diameter of HFr EF was higher than that of the other two groups(43 vs 40,P < 0.05;43 vs 40,P <0.05).5.In the comparison of drug use,there were statistically significant differences in ACEI,ARB,diuretics,digitalis,CCB,energy metabolism drugs and anticoagulants(P < 0.05),while there was no significant difference in the use of β-blocker,aldosterone,nitrate,antiplatelet and recombinant human brain natriuretic peptide among the three groups(P > 0.05).The use of energy metabolism drugs was the least in HFmr EF and the most in HFp EF,while the use of anticoagulants was just the opposite(P < 0.0176).The use rate of ACEI drugs in HFmr EF or HFr EF was higher than that in HFp EF(36.58% vs 25.81%,P < 0.0176;38.32% vs 25.81%,P < 0.0176),while that of ARB drugs was the opposite(21.75% vs 31.89%,P < 0.0176;23.10%vs 31.89%,P < 0.0176).The use of diuretics(73.48% vs 67.77%,P < 0.0176;73.48% vs 66.81%,P < 0.0176),digitalis(29.44% vs 24.37%,P < 0.0176;29.44% vs23.86%,P < 0.0176)in HFr EF was more than that in other two groups,and the use of CCB was less than that in other two groups(17.75% vs 23.48%,P < 0.0176;17.75%vs 25.81%,P < 0.0176).The difference of hospitalization days,hospitalization expenses and medicine expenses among the three groups was statistically significant(P < 0.05).The hospitalization days and drug cost of HFmr EF or HFr EF were lower than those of HFp EF(P < 0.05).The cost of hospitalization in HFmr EF was higher than that in HFr EF(P < 0.05).6.In this study,178 cases(8.19%)were rehospitalized for heart failure within 24 months,and 26 cases(1.19%)died.There were significant differences in rehospitalization and mortality among the three groups(P < 0.05).The number of rehospitalization in HFmr EF or HFr EF was lower than that in HFp EF(5.84% vs 15.40%,P < 0.0176;6.60% vs 15.40%,P < 0.0176).The mortality rates of HFmr EF was lower than that of the other two groups(0.38% vs 1.95%,P < 0.0176;0.38% vs 1.52%,P < 0.0176).7.Single factor Logistic regression was used to show LVEF,ACEI,ARB,aldosterone,diuretic,digitalis,CCB,energy metabolism,antiplatelet,anticoagulant,myocarditis,arrhythmia,diabetes,renal insufficiency,fatty liver,pulmonary infection,anemia,hyperlipidemia,hypoproteinemia,smoking,NYHA class,age,systolic blood pressure,left atrial diameter,left ventricular end diastolic diameter,glutamic pyruvic transaminase,creatinine,albumin,glutamic oxaloaminase,blood potassium and the level of RBC were all correlated with rehospitalization(P < 0.05).Multivariate analysis showed that EF,nitrates,antiplatelet drugs,myocarditis,diabetes mellitus,fatty liver,hypoproteinemia,NYHA class and level of RBC were the main influencing factors(P < 0.05).Antiplatelet drugs and RBC level were protective factors for rehospitalization.The risk of rehospitalization was 0.526 times lower in patients with antiplatelet drugs than in patients without antiplatelet drugs(1-0.474 = 0.526).The risk of rehospitalization was lower in patients with higher level red blood cells [or(95% CI): 0.586(0.432,0.794)].The risk factors of re-entry were EF,nitrates,myocarditis,diabetes,fatty liver,hypoproteinemia and NYHA class.The risk of rehospitalization in HFp EF group was 2.570 times higher than that in HFmr EF [or(95% CI): 2.570(1.419,4.654)],the risk of rehospitalization in patients treated with nitrates was 1.872 times higher than that in patients without nitrates [or(95% CI): 1.872(1.063,3.296)],and with myocarditis was 19.413 times higher than that in patients without myocarditis[or(95% CI): 19.413(1.848203.9)02),with diabetes was 1.753 times higher than that in patients without diabetes [or(95% CI): 1.753(1.104,2.782)],with fatty liver was 3.561 times higher than that without fatty liver [or(95% CI): 3.561(1.409,8.997)],and with hypoalbuminemia was 1.945 times higher than that without hypoalbuminemia [or(95% CI): 1.945(1.151,3.286)],patients of NYHA IV was4.201 times higher than that of NYHA II [or(95% CI): 4.201(1.97,8.959)].Conclusions:1.Compared with HFpEF,patients with HFmrEF or HFrEF had more males,lower mean age,lower systolic blood pressure.2.Compared withHFp EF group,patients with HFmr EF or HFr EF were less to have renal dysfunction,pulmonary infection,cerebrovascular disease,hypoproteinemia.3.ARB drugs are often used to replace ACEI drugs for patients with HFp EF.4.The overall prognosis of HF patients with different EF was different.The number of rehospitalization in HFp EF is higher than others,while all-cause mortality was lowest in HFmr EF.5.Ejection fraction,nitrates,antiplatelet drugs,myocarditis,diabetes,fatty liver,hypoproteinemia,NYHA class and RBC level were the main influencing factors for rehospitalization of HF.6.HFmr EF is a distinct category which was found to be intermediate to HFr EF and HFp EF in terms of clinical characteristics and resembled HFrEF closer than HFpEF.