Research Of Prognosis And Its Influencing Factors Among Discharged Patients With Heart Failure

Background:Decades of studies in foreign countries show that prognosis of heart failure has been improved, with decreased rates of rehospitalization and mortality after patients discharge; but compared to foreign countries, especially since the year of2007, the prognosis of discharged heart failure patients in domestic was not clear, and associated factors affecting the prognosis of heart failure patients also need to be further explored. So, the aims of this study are to know the prognosis of discharged heart failure patients and explore its influencing factors as well as provide baseline data supporting to improve the outcomes of heart failure patients.Objectives:Describing the one year rehospitalization, mortality and quality of life among heart failure patients after they were discharged from hospital. Surveying the changes of medication adherence, life style and behaviors, depression and quality of life among heart failure patients after being discharged3or6months. Exploring the influencing factors that affecting rehospitalization or mortality of heart failure patients. Methods:Heart failure patients admitted in hospital with NYHA functional classifications II-IV were included in the study during Mar.2011-Oct.2011; and data of baseline, medication adherence, life style and behaviors, depression and quality of life data were collected at the time of hospitalization; and after patients being discharged, a telephone follow-up was performed every month within1year. Associated factors that affect the rehospitalization and mortality of discharged heart failure patients were analyzed by multivariable Cox regression model.Results:258cases of heart failure patients were included in this study eventually, the mean follow-up time was about202days. The rates of heart failure caused rehospitalization after discharge from1,3,6to12months were1.9%,10.1%,14.3%,17.4%respectively; mortality rates were2.3%,6.6%,8.9%,11.6%respectively; combination of rehospitalization or mortality rates were4.3%,16.7%,23.3%,29.1%respectively. The quality life of heart failure patients were poor, with mean MLHFQ (The Minnesota Living with Heart Failure Questionnaire, MLHFQ) scores57.36±22.07, but the quality of life significantly improved after patients discharged3or6months (Kruskal-Wallis test, χ2=74.167, P=0.000). Kaplan-Meier survival curve analysis show significantly differences among groups of education, income, NT-proBNP, NYHA functional classifications and whether anemia, hyponatremia, surgery treatment (Log-rankχ2＝8.135, P=0.043; Log-rankxχ2＝8.294, P=0.040; Log-rankχ2＝9.385, P=0.002; Log-rankχ2＝7.605, P=0.006; Log-rankχ2=11.278, P=0.004;Log-rankx2=8.088, P=0.018;Log-rankχ2=8.889, P=0.003). Multivariable Cox Regression Model shows that the level of hemoglobin concentration (RR=0.982,95%CI,0.966～0.999; P=0.034), blood sodium (RR=0.913,95%CI,0.834～0.999; P=0.048), NT-proBNP (RR=3.088,95%CI,1.343-7.102; P=0.008), surgery treatment (RR=3.462,95%CI,1.122-10.687; P=0.031), and gender (RR=0.366,95%CI,0.155～0.864; P=0.022) are the main influencing factors of rehospitalization or mortality in discharged heart failure patients. For pre-hospitalization heart failure patients,52.9%can completely adhere to medication regimen, with percentage rates of smokers, drinkers, regular exercisers, fluid restriction, sodium control, monitor body weight and depression being14.3%,21.7%,55.4%,27.9%,57.4%,14.0%,61.6%respectively, furthermore, with mean CDS scores94.96±15.57. After being discharged3or6months from hospital, percentage rates of adherence to medication regimen, regular exercise, fluid restriction, sodium control and monitor body weight increased to91.4%-91.8%,62.2%-74.6%,78.9%-81.2%,80.3%-81.7%,32.4%-39.5%respectively (χ2=104.703, P=0.000; χ2＝8.980, P=0.011; χ2=33.425, P=0.000;χ2=151.785, P=0.000;χ2=38.617, P=0.000), while percentage rates of smokers, drinkers and depression decreased to8.6%-13.5%,2.5%～4.1%,23.1%-26.7%respectively (χ2=14.747, P=0.001; χ2=22.077, P=0.000;χ2=25.261, P=0.000); what’s more, the CDS scores significantly decreased (Kruskal-Wallis test, X2=23.301, P=0.000), and with revisit examination rates of78.7%within6months of discharge.Conclusions:Compared to the studies before2007, the prognosis of heart failure patients in this study have been improved, with rates of one year heart failure caused rehospitalization and mortality decreasing. Notwithstanding the pre-hospital of quality life, medication and life style adherence were poor, and with high percentage of depression; they all can be significantly improved after being discharged3or6months. What’s more, the rates of depression, complying to body weight monitor, regular exercise and within six months examination revisit still need further improving. Multivariate analysis show that gender, surgery treatment and levels of hemoglobin concentration, blood sodium, NT-proBNP were the main influencing factors that affect the rehospitalization or mortality in heart failure patients.