| ObjectiveTo investigate the effects of ivabradine on resting heart rate,serological parameters,echocardiographic parameters,quality of life score,drug safety and endpoint events in elderly patients with chronic heart failure complicated with diabetes mellitus.It provides a reference for ivabradine’s clinical application.MethodsThe elderly patients with chronic heart failure complicated with diabetes admitted to the Affiliated Hospital of Qingdao University from October 1,2020 to October 1,2021 were selected as the study subjects.The clinical data of patients were collected,who meet the standards for inclusion and exclusion.They were divided into control group and observation group according to different treatment regiments.The control group was treated with hypoglycemic and anti-heart failure treatment,while the observation group was treated with ivabradine on the basis of hypoglycemic and antiheart failure treatment.The endpoint events were cardiovascular death or readmission due to worsening heart failure,and all patients were observed for 12 months.The data of resting heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),serological parameters,echocardiographic parameters,Minnesota Heart Failure Quality of Life Questionnaire(MLHFQ),drug safety and endpoint events were collected up before and after medication.Serological parameters included: highsensitivity C-reactive protein(hs-CRP),N-terminal pro-B-type natriuretic peptide(NTproBNP),fasting blood glucose(GLU),glycosylated hemoglobin(HbA1c).Echocardiographic parameters included: left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),stroke volume(SV),left ventricular mass index(LVMI),left ventricular early diastolic mitral flow maximum velocity/early diastolic mitral annular peak velocity(E/e).MLHFQ was used to evaluate the quality of life.The changes of HR,SBP,DBP,serological parameters,echocardiographic parameters,and MLHFQ were compared before and after medication.The adverse reactions of drugs were observed,and the cumulative survival rate was calculated according to the survival curve of endpoint events.The significant univariate variables were analyzed by multivariate COX regression.Results1.The study included a total of 218 patients,including 108 in the observation group and 110 in the control group.The indicators before medication of the two groups was compared,and there was no statistically significant(P>0.05).These indicators including: age,gender,body mass index,past medical history,cardiac function classification,clinical medication,serological parameters,echocardiographic parameters,and Minnesota quality of life score.2.The indicators before and after medication were compared,found that the two groups after medication in patients with HR,hs-CRP,NT pro BNP,LVEDV,LVESV,LVMI,E/E),MLHFQ significantly reduced,LVEF,SV increased significantly,with statistical difference(P < 0.05);The difference between the two groups before and after medication was compared.It was found that HR,hs-CRP,NT-pro BNP,LVEDV,LVESV,LVMI and MLHFQ decreased more significantly in the observation group after medication,while LVEF and SV increased more significantly,with statistical significance between the two groups(P < 0.05).The SBP,DBP,GLU and HbA1c of the two groups were compared,the difference was statistically significant(P > 0.05).3.Kaplan-Meier method was used for survival analysis of endpoint events of the two groups,and the cumulative survival rate of patients in the two groups was calculated and compared,with statistical difference(P=0.015).Univariate analysis of readmission for cardiovascular death or worsening heart failure in elderly patients with chronic heart failure complicated with diabetes mellitus: HR,LVEF,SV,ivabradine,ARNI,SGLT-2i,MLHFQ were all associated with the occurrence of endpoint events(P<0.05).Multivariate COX regression analysis showed that ivabradine,ARNI,SGLT-2i treatment and improvement of MLHFQ could reduce the risk of cardiovascular death or rehospitalization for worsening heart failure in elderly patients with chronic heart failure complicated with diabetes(P<0.05).4.During the follow-up period,the main adverse reactions in the control group were sinus bradycardia,and the main adverse reactions in the observation group were sinus bradycardia and flash phenomenon.There was no discontinuation due to adverse drug reactions in either group.Conclusion1.Early use of ivabradine can significantly improve heart rate,left ventricular function,improve quality of life,improve prognosis,to some extent,make up for the lack of β-blockers.The application of ivabradine will not affect hemodynamics,blood pressure and blood sugar levels.2.The survival curves of the two groups of patients were described,and it was found that ivabradine could further reduce the risk of cardiovascular death or rehospitalization for worsening heart failure in elderly patients with chronic heart failure complicated with diabetes,and reduce the readmission rate.3.Ivabradine is well tolerated and safe in elderly patients with chronic heart failure complicated with diabetes mellitus. |
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