| BackgroundChronic heart failure (CHF) refers to a clinical syndrome characterized by fluid and sodium deficit and insufficient perfusion into peripheral tissues caused by incapability of the heart to pump enough blood to meet metabolic demands of the body with proper vein volume refluence on the basis of all kinds of heart disease. It is a common complication occurring in old patients.According to the latest estimation of the WHO, the incidence of heart failure (HF) is 1.5%~5.6%, which increases rapidly with increasing age and increasing population of old people, presumably 7.4% for people older than 65 years and 10% for people older than 80. At present, we have had more systemic knowledge about the etiology, mechanism, pathophysiologic changes, diagnosis and treatment, but most of the studies on HF focus on adults. There are few data on special age groups. With our country striding forward to aged society and changes of disease types, it is important to study the special colony. Literature has demonstrated that HF in old patients have poorer prognoses because of degeneration of the cardiovascular system with aging and particularity of diseases with old patients especially for elderly patients (=80 years), who have acute severe onset and atypical symptoms and are liable to have severe complications of major organs. The incidence of cardiogenic shock in old patients is 5.03 times that and has fatal prognosis. Based on the above statistical data, we can see that with the development of the whole world to aged society, prophylaxis and treatment of HF in elderly patients have become a prominent and urgent problem both for medicine and society.Objectivewith controlled analysis of clinical symptoms between different age groups with HF, the age-following characteristics of old HF patients were investigated in order to provide proof for clinical diagnosis and treatment especially forObjects and methods1. Objects: The subjects were 532 HF patients hospitalized from December 1999 to December 2004. They included 311 males and 221 females older than 60 years.2. Methods: 1. Specialized personnel of the hospital were assigned to conduct the retrospective review of the data of selected patients, including general clinical materials, underlying cardiac diseases, contributing factors, co-existing diseases, clinical symptoms, relative lab data, follow-up information, actual drug administration and therapeutic outcomes. 2. According to the age, patients were divided into 3 groups: 60~69-year age group (group 1, n=246), 215 cases in 70~79-yeasr age group (group 2, n= 215), and 80-year and older group (group 3, n=71). Database was established with EXCEL procedure and SPSS 10.0 software for windows was used for statistics.Results(1) Classification of cardiac function for different age groups with heart failure: grade II, grade III and grade IV cardiac function accounted for 53%, 28% and 28%;31%, 46% and 44%;and 16%, 26% and 28% in group 1, 2 and 3 respectively. The proportions of grade IV cardiac function increased gradually in each group, indicating that the severity of HF aggravated withincreasing age, and the difference was statistically significant (P<0. 05). (2) The distribution of HF types: the proportion of CHF decreased gradually, while the proportion of acute left heart failure and diastolic heart failure increased gradually with increasing age. (3) The constitutional information of causes in all groups: the most common combination was coronary heart disease with hypertension in double causes group. (4) With society aging, the incidence of single-cause HF decreased gradually in all three groups, while that of multi-factorial heart failure increased gradually. (5) Clinical characteristics of HF in different age groups: atypical HF symptoms increased with age and the proportion of typical HF-induced dyspnea was lower, while cough, sputum production, spiritual disorders and gastroenteric symptoms gradually appeared. Elder group had more atrial fibrillation patients compared with the other two groups (31.2% versus 17.8% and 20.8%). (6) Drug usage of different age groups: The results of the study demonstrated that the three most common drugs used for HF were nitrates, diuretics and digoxin, and the primary aim of the traditional treatment for HF was still to strengthen the heart, correct fluid/electrolyte disturbance and dilate the coronary artery. (7) The morbidity of the vital organs including the lungs, brain and kidneys increased with increasing age.Conclusion1. Most patients in the three age groups had grade II cardiac function and the patients of grade III become more gradually with age growth. 2. Atypical HF symptoms gradually decreased with age, especially in elder patients. 3.The proportion of HF patients with multiple causes increased with age and coronary disease combined with hypertension and diabetes became the most common combination. Coronary disease and hypertension were themain causes in elder HF patients. 4.The treatment in this hospital for elder HF patients includes nitrates, diuretics and digoxin.
|
PDF Full Text Request