Retrospective Analysis Of 614 Patients With Heart Failure And The Rapeutic Effect Of Statins

Backgroud:Heart failure(HF) refers to any causes of myocardial injury, cause changes in the myocardial structure and function, reduce ventricular pump function caused by the complicated clinical syndrome, is the end stage of various heart disease; and has already become the serious influence cardiovascular disease of public health. Heart failure(HF) is a major public health issue with a current prevalence of over 5.8 million in the USA and over 23 million worldwide. Every year in the USA,more than 550,000 individuals are diagnosed with HF for the first time. With the constant improvement of the ageing of the population, the prevalence of heart failure will further increase. How to prevent the occurrence of heart failure development, reducing the morbidity and mortality is an important subject in front of us, it also has become a hot cardiovascular epidemiology. Epidemiological investigation of HF can clarify its etiology and risk factors, prevention and treatment, to guide the prevention and therapy of heart failure.Objective:1 To investigate the gender, age, distribution, and the causes of hospitalized patients with heart failure(HF)of Hebei in China.2 By means of the statistics of the living environment,stratum,clinic experience,hospitalization days and medical expense of hospitalized patients of heart failure, to discuss the influence of the cause of disease in patients with heart failure by different periods, regional and economic condition.3 To investigate the risk factors of heart failure, the hospitalization rates, mortality and cause of death of the hospital patients for three to five years.4 To investigate the prognosis of patients with heart failure with using or not using statins. In order to provide a reference for future clincal treatment of hospitalized patients through using statins.Method:Retrospective analysis was used to research the hospitalized patients with HF from January 1, 2009 to December 31, 2011 in the department of cardiology of 2nd hospital of Hebei Medical University(with the standard of LVEF≤50%,BNP≥400pg/nl,NYHA Ⅱ-Ⅳlevel), and the patients who were hospitalized and diagnosed with HF more than once were only counted at the last time, the other times of hospitalizition were not counted. Except of those patients which have a long history of other provinces and cities to live or treatment, special life, custom, hobby, family history, or treatment and cor pulmonale and chronic renal failure. The basic characteristics of hospitalized patients with HF, risk factors(such as smoking,drinking,hepertension,hyperlipoidemia and diabetes mellitus) of HF, Telephone follow-up courtyard outside the patient’s medication adherence, and hospitalization rates, mortality and cause of death. Review the echocardiography to exceed contrast the change of inside and outside hospital left ventricular ejection fraction, separatelly carries on the statistical analysis. Statistical methods: SPSS13.0 statistical software was used in the data analysis, the measurement data of normal distribution were expressed as mean±standard deviation, the two sample mean comparison was used the independent sample t test;the enumeration data was used the chi-square test, and P<0.05 was considered statistically significant. Pathogenic factors compared was used logistic regression analysis.Results:1 There was a tatal number of 614 cases, the age of patients ranged between 14 to 88, the average of age was 60.17±12.93 years old. The proportion of male was 63.5%, and female was 36.5%. The ratio of male to female was 1.74:1. As the growth of the age, the proportion of heart failure increased gradually, with the highest proportion of 60 ~ 69 years group( 33.55%).According to the gender, men and women were divided into two groups, in every age group,men are more than women(P<0.05).2 The top four causes of HF in patients were CHD(coronary heart disease), DCM(dilated cardiomyopathy), HT(hypertension), RHD(rheumatic heart disease). The highest proportion of CHD, at 47.1%; followed by DCM and HT, at 30.45% and 11.23%; again for RHD, at 5.4%.In CHD, the elderly is in the majority,though in DCM, the young and middle-aged is in the majority(P<0.05). According to the gender, there was no obvious difference in different gender in the period of its eliology in all age groups(P>0.05).3 The hospitalized days of patients ranged between 1-40, the average of day was 10.9±5.1day. The total expense ranged between 764.08-134065.9 yuan, the average cost was 14762.5±10491 yuan. According to the NYHA Heart function classification, the two degree was 77 cases(12.5%), the three was 316 cases(51.5%), the four was 221 cases(36%). Contrast to 09,10,11 years, the proportion of patients of new farmers in medical properties is increasing, from 10.71% to 45.25%. The proportion of CHD is the same to DCM in rural patients, respectivelly 39.8% and 35.4%, the proportion of HT is 11.3%; the respective proportion are 56.0%,15.3%,16.7% of CHD,DCM,HT in city patients, the main is CHD(P<0.05). In the clinic experience, there are 61.2% of patients choose to the clinics or hospitals at the county level, as the illness aggravating to choose to the provincial hospital. Rural patients with first onset directly to the provincial hospital is only 24.7%, and there are almost half of the patients in intellectual preferred at the provincial level(45.97%) or above.4 The pathogenic factors for HF patients are age,sex,smoking,drinking,hypertension,hyperlipoidemia,diabetes,stratum,and living environnment. Theage and sex are unchanged factors, the other are changed. In the changedfactors, smoking,HT and stratum have an impact on the etiology of heartfailure(P<0.001).The smoking HT and stratun will increase the proportionof the patients with ischemic heart failure.5 Telephone follow-up of 366 cases. The case of male was 237, and female was 129. The rehospitalized patients were 114 cases(31.15%)from three to five years, the death were 182 cases(49.73%). The cause of death of HF is pump failure,arrhythmia and sudden death in order. The cause of death of non-HF is AMI,renal failure and other causes. In the death, the proportion of ischemic heart failure is 50.5%,the non-ischemic heart failure is 49.5%, there was no obvious difference(P>0.05).6 The cases of patients who used stastins are 235, the proportion of the ischemic heart failure is 71.5%, the non- ischemic heart failure is 28.5%. There was no obvious relation between the cause of the rehospitalization(P>0.05). At the same time, there was no obvious relation between treated with and without stastins in the death(P>0.05). According to the division of ischemic and non ischemic etiology, and application in hospitalized patients with ischemic heart failure and statin shows significant difference(P < 0.05);Die application with statins in patients with no significant difference(P > 0.05).In patients with ischemic heart failure and hospitalization and death with application statin there was no significant difference(P > 0.05). There are 36 cases of patients who review UCG in our hospital. 34 cases lobbyists continue to take drugs, diuretics, beta-blockers, ACEI and ARB, aldosterone receptor antagonist).There was no obvious improvement between treated with and without stastins in LVEF( P 均>0.05).Conclusions: 1 The number of HF cases increased with the increasing of age,the largest proportion of 60-69 years-old group.According to the gender group, there were more male than female in each years-old group.2 The top four causes of HF in patients were CHD, DCM, HT, RHD. In elderly patients, the top cause is CHD; but in young and middle-aged patients, the proportion of DCM is higher.3 With the development of economy and improvement of medical conditions, gradually improve the proportion of new farming in patients. But in the clinic experience, nearly more than half of rural patients preferred local clinics or hospitals at the county level, as the illness aggravating to choose provincial hospital. Rural populations of people is given priority to with coronary heart disease(CHD) and the DCM, the city people with coronary heart disease(CHD).4 In the pathogenic factors for heart failure, History of smoking, hypertension and stratum will increase the proportion of patients with ischemic heart failure. The rehospitalization rate and mortality are still high. Heart failure patients rehospitalized and death have no obvious relation with ischemic or non ischemic. The leading cause of death are pump failure,arrhythmia and sudden death.5 Hospitalization for heart failure patients, statins is commonly used in patients with ischemic heart failure, heart failure patients with non-ischemic less application. Application of statins can reduce rehospitalization rate, but not reduce mortality and LVEF in patients with heart failure;application of statins can not reduce rehospitalization rate,mortality and LVEF in patients with heart failure.