| BackgroundChronic heart failure is a syndrome caused by different chronic organic cardiovascular diseases leading to cardiac pump dysfunction at last. According to the latest foreign epidemiological data of CHF, the incidence of the adult population in developed countries was about1～2%, it could be as high as10%in the elderly population over the age of70. According to a domestic epidemiological study, the incidence of heart failure in China was0.9%, which was estimated to about4million patients with heart failure in adults between35～74years old in China. Usually the patients with heart failure have a poor prognosis, the annual mortality rate of mild heart failure is about5～10%, the severe patients could be as high as40%, which is higher than some malignancies. The increasing number of patients with heart failure is ascribed to the improvement of heart failure treatment, which can reduce the mortality of these diseases and then these patients suffer from heart failure. Studies show that in the past50years, the survival rate of heart failure improved continuously. It’s mainly due to the progress of the pathological mechanisms of chronic heart failure and the carrying out of evidence-based medicine experiments, and a set of standardized treatment of chronic heart failure which is based on neuroendocrine antagonists is gradually established and recognized by different countries. Once the chronic heart failure is diagnosed, we should start ACEI and β-blocker therapy at once, and it should be started from a very small dosage to the target dosage gradually. Patients who can not tolerate ACEI that use ARB instead.Although the efficacy of standardized treatment of chronic heart failure is recognized by the world including our country, but because of China’s vast territory, large population and the unbalanced distribution of social medical resources, the standardized treatment of chronic heart failure is still in the start-up phase. According to a Chinese primary hospital survey about the drug treatment of heart failure, the utilization of β-blocker was40%, the utilization of target dose was only1%, the utilization of ACE1was80%, the utilization of target dose was only2%.The geographical analysis found that the situation was particularly severe in remote areas. Another retrospective survey shows that in the20years between1980-2010, the utilization of digitalis decreased to40.3%from51.7%, while the utilization of p-blockers, ACEI, ARB increased to19.0%,40.4%,4.5%from8.5%,14.0%,0.5%. The neuroendocrine antagonists treatment of heart failure is gradually accepted by Chinese doctors, but the utilization rate especially the target dosage utilization is still very low. Standardized treatment of chronic heart failure can reduce mortality and hospitalization rate, which will help the long-term prognosis of patients and can gradually reduce the huge medical costs of hospitalization for heart failure, so the standardized treatment of chronic heart failure should be promoted urgently.ObjectiveTo verify the efficacy and safety of the standardized treatment of chronic heart failure, try to establish a set system of CHF patients’ management, improve the prognosis of patients.Methods1. Collecting patientsCollect the patients treated by the standardized treatment of CHF who meet the inclusion criteria and exclude the contraindications.2.Standardized treatmentPatients meet the inclusion criteria and exclude contraindications, began to use β-blocker and ACEI starting from a very small dosage, monitor the resting heart rate, blood pressure, as well as the daily weight, if patients can tolerate this dosage, it should be doubled every2-4weeks until to the target dosage or the maximum tolerated dosage. The different patient’s dosage is not identical, if the patients who can not tolerate the increased dosage due to hypotension or other symptoms, may consider the use of diuretics (spironolactone combined with loop diuretics) and/or a small dosage of digoxin, if the patients still can not tolerate, the previous dosage is the maximum tolerated dosage for this patients and should be long-term maintenance. If the patients can not tolerate ACE1(such as severe dry cough), it can be replaced by ARB. If the dosage reaches to the target dosage, it should be maintained for long term.3. Data AcquisitionRecord patients’gender, age and other basic information, record the heart rate, blood pressure, NYHA classification in different treatment phase. Measure the LVEDD and LVEF by echocardiography before treatment and3months later when the dosage reaches to the target dosage. Fill in the Minnesota Living with Heart Failure Questionnaire (MLHFQ) before treatment and3months later when the dosage reaches to the target dosage and record the dates.SPSS19.0is used to the statistical analysis process. The dates are expressed by mean and standard deviation(x±s). Use the paired samples t-test or sample means t-test to compare all of the results, One-way ANOVA analysis method is used to compare the multiple groups and P<0.05is considered significant.ResultThe patients’average age is52.2±12.0years old, the ratio of male and female is19/11, heart failure reasons:coronary heart disease50.0%, primary cardiomyopathy13.3%, and cardiomyopathy caused by other reasons36.7%. The systolic blood pressure is137.2±18.8mmHg, diastolic blood pressure is86.9±15.1mmHg, heart rate is80.3±9.2beats/min before the standardized treatment, and after treatment the systolic blood pressure is126.5±17.7mmHg. diastolic blood pressure is79.8±8.7mmHg, heart rate is62.4±6.7beats/min, the systolic blood pressure, diastolic blood pressure and heart rate have the statistical difference before and after treatment (p<0.05). NYHA classification before treatment is3.2±0.7,it becomes1.5±0.6after the treatment, there is a statistically significant difference before and after treatment (P<0.05). Echocardiography:Before treatment:LVEDD65.8±10.8mm, LVEF30.9%±7.0%; after treatment LVEDD61.0±11.6mm, LVEF44.0%±14.2%, both LVEDD and LVEF have the statistically significant difference before and after treatment (P <0.05). Minnesota Living with Heart Failure Questionnaire (MLHFQ):before treatment:synthesis score is37.8±17.8, body field score is11.7±7.5, emotional field score is11.0±5.9; after treatment:synthesis score is21.2±11.5, the body field score is7.8±5.4, emotional field score is5.7±3.3. MLHFQ synthesis score, body field score and emotional field score have the statistically significant difference before and after treatment (P<0.05).Subgroup analysis:according to the left ventricular systolic function it can be divided into three groups in the way of retrospective analysis: markedly group (LVEF>50%), effective group, invalid group. The age, NYHA classification. LVEF do not have the statistically different (P>0.05), but LVEDD in the markedly group is significant different from other groups (P<0.05).ConclusionStandardized treatment of chronic heart failure has a good clinical effect. The patient’s heart rate and blood pressure can be decreased to an appropriate level, and the LVEDD, LVEF, NYHA classification and the MLHFQ scores are modified to a better state. Subgroup analysis shows that the patients with good efficacy have smaller LVEDD before treatment, but the patient’s age, NYHA classification. LVEF before treatment have no statistically significant difference. So it has a high value and should be spread. |
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