| Objective:To analysis the clinical characteristics, aetiology, drug therapies and prognosis of hospitalized patients with chronic heart failure(CHF) in the second hospital of Hebei Medical University in the years of 2009 and 2014, and review the trend of variables above as time went by. A conclusion could be made about the condition of epidemiology and diagnosis and management of hospitalized cases with chronic heart failure. At the sametime, precious data was collected for the more large-scale epidemiologic survey in our hospital in future days.Methods:The hospitalized cases with chronic heart failure as the primary diagnosis at discharge were collected in 2009 and 2014(from January 1st 2009 to June 30 st 2009 and January 1st 2014 to June 30 st 2014) in the second hospital of Hebei Medical University. More items including gender, age, the days in hospital, aetiology, the classification of cardiac function, comorbidities, the equipmental and laboratory examinations of electrocardiography, echocardiogram, X-ray chest radiogram, B-type natriuretic peptide(BNP), routin blood and renal and liver function, drug treatment and hospitalized outcomes were recorded in detail. A retrospective method was adopted to analysis and compare the case data.Results:1 A total of 857 hospitalized cases with CHF were enrolled with 325 patients in 2009 and 532 patients in 2014, respectively, with the proportion of CHF hospitalization to the whole cardiac cases being 8.48% in 2009 and 10.65% in 2014 at the same period. The proportion of CHF patients in-hospital increased significantly in 2014 compared to 2009(χ2=11.642,P=0.001).2 In the comparison of 2014 to 2009, the mean in-hospital duration of patients with CHF was respectively(10.86 士 5.12) days and(12.07 士 5.85) days, with being shorter significantly in 2014(P=0.002); the rates of patients with cardiac function of level Ⅱ, Ⅲ and Ⅳ were 25.19%, 49.62%, 25.19% and 21.23%, 44.31%, 34.46% in turn, in which the number of patients with cardiac function of level Ⅱ, Ⅲ increased meanwhile that of patients with cardiac function of level Ⅳ decreased, thus significant difference was seen in the composing proportion of cardiac function(P=0.014). In this survey, there were 50.77% and 53.57% cases of male and 49.23% and 46.43% cases of female in 2009 and 2014 respectively with no statistical meaning in gender proportion between the two years(P=0.442). The mean age of CHF patients was(65.27±12.50) years in 2009 and(65.39±13.45) years in 2014 with no significant difference(P=0.893); among them, the rates of older cases whose age was over 60 years old were 71.38% and 70.49% in 2009 and 2014. The component ratio of age was not significantly changed between the two years(P=0.722).3 To be compared with 2009, the proportion of coronary atherosclerotic heart disease(CHD), hypertension and non-rheumatic valvular heart disease had the trend of increasing in 2014, in which the rate of CHD increased from 51.08% to 55.26% and the rate of hypertention rose from 14.77% to 16.17%, in addition with that of non-rheumatic valvular heart disease had the trend of increasing from 5.53% to 7.89%, but the differences above were not significant(P=0.233、0585、0.190). While the proportion of rheumatic heart disease(RHD) and dilated cardiomyopathy(DCM) had the distinct trend of decreasing in 2014, in which the rate of RHD decreased from 12.31% to 6.58% and that of DCM fell from 12.92% to 5.83%; the differences of RHD and DCM were significant(P<0.0001、P=0.004). CHD and hypertension were the first two causes in the spectrum of aetiology in the two years; in addition, the order of non-rheumatic valvular heart disease had rose from the fifth in 2009 to the third in 2014, respectively, the order of DCM had fallen from the third in 2009 to the fifth in 2014.4 Among comorbidities in patients with CHF, the rates of patients with pulmonary infection, diabetes mellitus, cerebrovascular disease, renal dysfunction and anemia were 36.00%, 26.77%, 15.08%, 6.46%, 6.15% in 2009, respectively, and the rates of these comorbidities were 44.17%、29.32%、20.68、14.10%、10.34% in 2014. Compared with 2014 to 2009, the number of patients with pulmonary infection, cerebrovascular disease, renal dysfunction and anemia increased significantly(P=0.018、0.04、0.001、0.035), while the changing of proportion of cases with diabetes mellitus had no statistical meaning(P=0.421).5 Compared with 2014 to 2009, the rates of the cases with pure DHF and mixture of SHF and DHF increased from 52.87% and 18.85% to 60.54% and 19.37% in 2014, among which there was no statistical meaning(P=0.060、0.789); and the rate of the cases with pure SHF decreased distinctly(19.73%vs.28.28%,P=0.014). The proportions of male cases and female cases with systolic heart failure were 64.86% and 35.14% respectively, while the proportion of male cases with diastolic heart failure fell down to 49.43% with the significant elevation in the rate of female cases(50.57%). There was distinct difference in the gender proportion of SHF versus DHF(P<0.0001). The proportion of patients with SHF older than 60 years was 43.63%, while that of patients with DHF whose ages were over 60 years occupied 80.29%, with distinct difference in the component proportion of age between SHF and DHF(P<0.0001).6 In the comparison of 2014 to 2009, among the traditional medications, the applicance rate of diuretics decreased obviously which accounted for 83.27% and 89.85% respectively, and the changing was distinct(P=0.008); the application rate of digitalis reduced significantly(50.15%vs.16.92%, P<0.0001). Renin angiotensin system inhibitors(angiotensin-converting-enzyme inhibitors(ACEI) and angiotensin receptor blockers(ARB)), beta-blockers and aldosterone receptor blockers had became the main drug therapies of CHF. To be compared with 2009, the application rates of RAS inhibitors and aldosterone receptor blockers increased in 2014(86.77%vs.89.29%, 80.45%vs.75.38%) with no statistical meaning; meanwhile, the usage rates of beta-blockers were 62.41% and 70.70%. The rates of the combination of RAS inhibitors and aldosterone receptor blockers and RAS inhibitors accompanied with B-blockers and aldosterone receptor blockers had distinct increasing as time went by(73.68%vs.67.38%、P=0.048, 42.29%vs.29.85%、P<0.0001).7 The mortality rates were 4.62% and 3.20% in 2009 and 2014 respectively. The fatality decreased in 2014 compared with 2009 with on statistical meaning(P=0.287).Conclusion:1 Compared with 2014 to 2009, the proportion of chronic heart failure to the whole cardiac diseases hospitalized patients increased.2 Compared with 2014 to 2009, the aetiology spectrum of the hospitalized cases with CHF changed markedly. CHD, hypertension and non-rheumatic valvular heart disease had the trend of increasing gradually, while RHD and DCM had the trend of decreaseing as time went by. CHD was the most main aetiology of patients with chronic heart failure.3 Pulmonary infection, diabetes mellitus, cerebrovascular disease, renal dysfunction and anemia were the common comorbidities in patients with CHF. In the comparison of 2014 to 2009, the morbidities of these concominants all increased.4 Compared with 2014 to 2009, the proportion of diastolic heart failure had the trend of rising, in which the cases of female and the elderly were common seen.5 Beta-blockers, RAS inhibitors and aldosterone receptor blockers had became the chief drug therapies of CHF. Compared with 2014 to 2009, the usage rates of RAS inhibitors and aldosterone receptor blockers increased and the combination of RAS inhibitors with B-blockers and aldosterone receptor blockers had distinct increasing; Diuretics was still the main conventional medication, in addition, the application rate of digitalis reduced markedly.6 The mortality rate of cases with CHF decreased in 2014 compared to 2009, but the changing had no statistical meaning. |
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