Combine Traditional Chinese And Western Medicine Curative Effect In Patients With Chronic Heart Failure Clinical Applicability

Backgroud and Objective:Clinical evaluation of Chinese medicine about chronic heart failure (CHF) is an important issue, which needs to be solved currently, among clinical evaluation of Chinese medicine prevention and treatment major or refractory disease. QOL outcome indicators are consistent with TCM characteristics and acknowledged globally. Using QOL evaluation indicators to assess the outcome and clinical efficacy of chronic diseases, has been accepted by the international medical experts. The purpose of this study is to explore evaluation indicators which are conducive to show the advantages of clinical efficacy of integrative treatment of CHF and TCM characteristics, by analyzing the relationship of QOL indicators and TCM symptom score, NYHA classification, six minutes’walk test, and commonly used laboratory indicators.Methods:This study was base on "heart failure QOL outcome indicators and evaluation criteria of the clinical efficacy of Chinese medicine research (30873256)", which is a longitudinal observational study.156inpatients of heart failure were collected in3hospitals from September2009to August2011. The patients received integrated traditional Chinese and western medicine treatment for two weeks. Before and after the treatment, the doctor should fill Heart Failure TCM Symptoms Scale, patients should fill MLHFQ and SF-36questionnaire, and the patients without difficulty to walk should take a six minutes’walking test. Investigators were responsible to fill in patients with NYHA classification and laboratory test results. T-test, rank sum test, analysis of variance and correlation analysis were used to estimate the relationship between NYHA, six minutes walk test, laboratory parameters (LVEF, BNP and CRP) and QOL outcome index.Results:①Quality of life scale, MLHFQ and SF-36, has well internal consistency reliability, discriminate validity, and well feasibility.②NYHA and QOL relationship, two weeks after the treatment, patients’different classification of NYHA MLHFQ score increased significantly(p<0.001), the integral differences were statistically significant. Patients with different classification of NYHA,before and after treatment scores of SF-36compare, patients’NYHA II scores of each dimensions of SF-36increased, physical health components, mental health components, role physical, bodily pain and role emotional has different statistical; patients’with NYHAIII scores of each dimensions of SF-36increased, the integral differences were statistically significant, the integral differences were statistically significant between NYHA IV according to before and after treatment SF-36scor, besides general health.③TCM symptom index and QOL relationship, the correlation coefficient between before treatment TCM symptoms scale and MLHFQ was-0.70,-0.58,-0.72, in physiology, emotion and total score respectively (p<0.001);the correlation coefficient between before treatment TCM symptoms scale and SF-36was-0.66,-0.62,-0.67, in physical health components, mental health components and total score respectively (p<0.001), the correlation coefficient of the8dimensions with-0.37to-0.62, with a negative correlation(p<0.001).Analysis of indicators of TCM symptoms and NYHA classification, the integral differences were statistically significant between different classification of NYHA according to before and after treatment TCM symptoms scale score(p<0.001), The correlation coefficient between before treatment NYHA classification and TCM symptoms scale was0.58, with a positive correlation(p<0.001).④To analysis six minutes walking distance and QOL, The correlation coefficient between before treatment six minutes walking distance and SF-36was a positive correlation in physical functioning, bodily pain, vitality, social functioning, role emotional, physical health components, mental health components and total score, the correlation coefficient with0.41to0.57, The relativity between the gap of before and after six minutes walk distance and each domain score changes of MLHFQ and SF-36was no statistically significant.⑤To analysis laboratory indicators and QOL, the correlation coefficient between LVEF and SF-36was-0.26, in role emotional,with a negative correlation(p<0.000);The relativity between BNP and CRP and each domain score changes of MLHFQ and SF-36was no statistically significant. The relativity between laboratory indicators and NYHA classification was no statistically significant.Conclusion:The patients QOL outcome measures can be regarded as suitable indicators to evaluate clinical efficacy of integrated traditional Chinese and western medicine treatment; TCM symptom score is able to better evaluate the clinical efficacy of CHF in integrated traditional Chinese and western medicine treatment objectively; but6MWD itself is influenced by many factors so that its feasibility needs to be concerned when applied; laboratory indicators and QOL index, and NYHA classification do not show correlation, thus laboratory indicators are recommended as reference indicators to evaluate clinical efficacy of integrated traditional Chinese and western medicine treatment.