| Background:The incidence of cardiovascular disease in the elderly gradually is increasing, such as Coronary artery disease, Hypertension, Arrhythmia. As the ultimate destination, the morbidity of heart failure in elderly is increasing. At present, the treatment of neuroendocrine antagonists and diuretics has become the standard therapy of chronic heart failure. A number of clinical studies showed that the usage rate of guidelines recommend medicine is low. There are few domestic and international researches on the long-term standardized treatment of the elderly.Objective:Through a retrospective review of the clinical data and use of anti-heart failure medicine of the chronic heart failure patients in Geriatrics department of the First Hospital of Jilin University during 2013—2015, to evaluate the efficacy of long-term standardized therapy in elderly patients with chronic heart failure, and to provide clinical experience for the treatment of chronic heart failure in elderly.Methods:There were 2164 patients were analyzed retrospectively in 2013 in Geriatrics department of the First Hospital of Jilin University. A total of 238 subjects, aged 80 years or higher (average 83.38±2.81 years),who was diagnosed with chronic heart failure(their NYHA class was II to IV) were selected for this study. And we reviewed their clinical data of hospitalized during 2013 to 2015. Based on treatment regime, they were assigned to A (standardized treatment group, n=162)、B (non-standardized treatment group, n= 76).Or based on left ventricular ejection fraction (LVEF), they were assigned to HFPEF group (LVEF≥45%, n=211) and HFREF group (LVEF< 45%, n=27) two groups according to the. The age, sex, underlying diseases and complicating diseases, the types of CHF (including HFPEF and HFREF), application of drugs, cardiac ultrasound (LVEF, LAD, LVED, and 1 year’s recovery rate,2 year’s recovery rate of patients and readmission for heart failure, death were determined to evaluate. The data were analyzed using SPSS 17.0 statistical software (SPSS 18.0). A value of P＜0.05 was considered statistically significant.Results:①Among 238 cases of elderly patients with heart failure,162 cases was in A group (68.07%) and 67 cases (31.93%) in B group; 211 cases (88.66%) were in HFPEF and 27 cases in HFREF (11.34%). The age and gender and two types of heart failure did not show difference in statistics during A and B group (P> 0.05). The age and gender did not show difference in statistics during HFPEF and HFREF group (P> 0.05). ② The top three underlying and complicated diseases were coronary artery disease, hypertension and arrhythmia in the elderly patients with heart failure. The incidence of underlying and complicating diseases has no significant difference in the A, B group (P＞0.05). Coronary artery disease, Hypertension, Arrhythmia, Renal failure, Diabetes and Pulmonary heart disease in the pathogenesis in two types of heart failure patients was no statistical difference (P> 0.05). ③ Frequency of medicine used for the heart failure treatment from high to low were β-blockers, diuretics, ACEI/ARB, spironolactone in elderly patients with heart failure. The use of beta blockers, ACEI/ARB, spironolactone and combination of three drugs was higher in group A than B, the difference was statistically significant (P＜0.05). ④ The proportion of patients with improvement of LVEF in group A was higher than that in group B after 2 years later, and the difference was statistically significant (P＜0.05). The improvement rate of LAD and LVED, the Re-hospitalization and hospitalization duration in group A were higher than group B 1 and 2 years later, and the difference was statistically significant (P＜0.05). Compared to A and B groups in type HFPEF heart failure and type HFREF heart failure respectively, the improvement rate after 2 years of LVEF and the Re-hospitalization for heart failure in group A was higher than group B. The improvement of the proportion of patients of LAD, LVED, the days of hospitalization for heart failure was higher than that in group B, there were statistically significant differences (P＜0.05). ⑤ The LAD、 the number of times and days of hospitalization for heart failure and the number of days of three years of A group has a decreasing trend, there is statistical significance (P＜0.05). The LVEF of B group in different years there was a reduction trend, and the LVED, LAD, the number of re hospitalization for heart failure showed an increasing trend, there was statistical significance (P＜0.05). ⑥ However, there was no significant difference in the number of three years in the B group (P＞0.05). There were no statistically significant differences in cardiovascular mortality and total mortality between 2 groups (A and B) (P＞0.05).Conclusion:1. The top three underlying and complicated diseases were coronary artery disease, hypertension and arrhythmia in the elderly patients with heart failure;2. The frequency of medicine used for the heart failure treatment from high to low were β-blockers, diuretics, ACEI/ARB, spironolactone in elderly patients with heart failure;3. Long term standardized treatment can reduce the left atrial diameter, shorten hospitalization, as well as reduce re-hopitalization. |
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