Investigation On The Treatment Of Elderly Patients With Chronic Heart Failure In Tianjin

Objective:Heart failure is a serious and terminal stage of a variety of heart diseases.Heart failure is one of the serious diseases that threaten the living conditions of the elderly.Epidemiological survey shows that the prevalence of heart failure increases with age.In adults,each hundred people about 1-2 heart failure patients,or the elderly over the age of 70,each of the 100 people have more than 10 heart failure patients With the aging of the population and the continuous improvement of the means of heart care and treatment,so that more and more patients with coronary heart disease were survival of acute cardiovascular events,the prevalence of heart failure will gradually increase.Heart failure patients have the characteristics of High hospitalization rate,high mortality rate.Five-year survival rate is only 50%.Heart failure as a serious public health problem has been highly concerned.In recent years,it has been demonstrated that the Golden Triangle(angiotensin-converting enzyme inhibitor / angiotensin receptor blocker,beta-blocker,aldosterone receptor antagonist)can significantly reduce the rehospitalization rates and mortality of heart failure with reduced left ventricular ejection fraction.So the international and domestic guidelines continue to update the treatment of heart failure recommendations to reduce HFr EF rehospitalization rate,mortality.In Europe and the United States and other developed countries,the guidelines compliance index of patients with heart failure is better,China has a certain gap compared with them.In Tianjin,the investigation of heart failure is limited,Especially on the elderly heart failure survey rarely reported.The aim of this study was to investigate the clinical characteristics of elderly patients with chronic heart failure in Tianjin,As well as the elderly(HFr EF)drug application,for the clinical standardization of treatment of elderly chronic heart failure(CHF)to provide information and basis.Methods: Using the multi-center,retrospective cross-sectional survey and analysis of nine hospitals in Tianjin(6 urban hospitals,3 suburban hospitals,covering a wide range,with a certain representative),from March 2014 to February 2016 period,A total of 1799 hospitalized patients with CHF as the main cause were included ?Of which 772 cases of normal elderly CHF patients(? 65-79 years),485 cases of Old age CHF patients(? 80 years),542 cases of non-elderly heart failure patients(<65years)were admitted as the control group According to age grouping,<65 years old for non-elderly group,? 65-79 years old for the normal elderly group,? 80 years old for the Old age group ? Each center has a fixed person to collect the case.According to the guidelines recommended standards and the contents of the questionnaire for team training.Everyone collects cases according to uniform standards.The collection includes general information,cardiac function classification,heart failure type,etiology and concurrent disease,drug treatment and other related data.To analyze the clinical characteristics of heart function classification,heart failure type,etiology and combined disease and drug therapy in elderly patients with heart failure and non-elderly heart failure.Analysis of elderly HFr EF drug treatment,especially the Golden Triangle drug,to evaluate HFr EF in patients with guidelines for compliance index.Results:(1)General information on patients with heart failure(1)1799 cases were collected.1107 cases were male patients,692 cases were female patients.The mean age(70.43 ± 12.56)years.Non-elderly heart failure patients accounted for 30.1%(542/1799),normal elderly group accounted for % 42.9%(772/1799);old age group accounted for 27.0%(485/1799);NYHA ?,? and ? were accounted for23.5%(422/1799)?48.3%(869/1799)?28.2%(508/1799);HFr EF,HFp EF and HFmr EF accounted for 43.4%(780/1799)?34.6%(623/1799)?22%(396/1799);Common etiology and complications :The first five diseases were 80.2% of coronary heart disease,60.9% of hypertension,39.0% of hyperlipidemia,33.5% of diabetes,30.7%of pulmonary infection;(2)Heart functionclassification was compared in patients of different age groups with heart failure The proportion of NYHA class II patients with heart failure was higher in normal elderly group.The proportion of NYHAIV patients with heart failure was higher in old age group.Indicating that with age,NYHAII heart failure patients gradually decreased,NYHAIV patients with heart failure gradually increased.(3)the distribution of heart failure types in different age groups The proportion of HFr EF patients in the non-elderly group was higher than that in the normal elderly group and old age group.The proportion of HFp EF patients in the old age group was higher than that in the normal elderly group and the non-elderly group,the difference was statistically significant(all P <0.05).Indicating that non-elderly heart failure patients prone to HFr EF,old age group heart failure patients prone to HFp EF.The distribution of HFmr EF in different age groups was not statistically significant.(4)The etiology and co-morbidity of heart failure in different age groups,he number of patients with heart failure in old age group and the normal elderly group was higher than that in the non-elderly group(all P <0.05).The number of patients with heart failure in old age group was higher than that in normal elderly group(all P <0.05).(5)Distribution of medication in patients with heart failure at different ages.The application of ACEI,ARB,?-blockers,digitalis,nitrates and energy metabolites were statistically significant(P <0.05).The proportion of ?-blockers and ACE inhibitors in non-elderly group was higher than that in the normal elderly group and the old age group(P <0.05).The application rate of digitalis,energy metabolites and nitrates in normal elderly group and the old age group was higher than that in the non-elderly group(P <0.05).(6)drug distribution in HFr EF patients a.?-blockers(80.3%),diuretics(78.1%),nitrates(68.1%),aldosterone receptor antagonists(61.9%)were used in the treatment of HFr EF patients as a whole.,ACEIs(33.8)digitalis(32.8%),ARBs(21.5%).b.the "Golden Triangle" drug applications in HFr EF patients of different age :With the growth of age,the application rate of?-blockers decreased.The application rate of ACEI / ARB has a tendency to decrease with age,but not statistically significant(p = 0.056).The distribution of aldosterone receptor antagonists in the three groups was not statistically significant.c.With the increase of age guidelines compliance gradually deteriorated,non-elderly heart failure group of patients with the best compliance,old age group heart failure patients guidelines compliance is the worst.Conclusion:(1)CHF patients with heart failure types have presented the following characteristics in Tianjin,With the increase of age,HFr EF gradually decreased,HFp EF accounted for gradually increased,HFmr EF to maintain the proportion of about 1/3,no change with age.(2)With age,NYHAIV patients gradually increased the proportion,indicating that elderly patients with CHF heart function worse,more serious heart failure.(3)The overall application rate of ?-blockers was higher(78.5%)in CHF patients with heart failure.However,with the increase of age,the application rate of ?-blockers decreased gradually,from the non-elderly group of 84.3% to the elderly group fell to 72.6%.Overall application rate of ACEI / ARB is low,only57.7%,significantly lower than the European level,there is a big gap.(4)For HFr EF patients,the guidelines recommended "Golden Triangle" drug use compared with non-elderly,the normal elderly,especially old age patients with ?-blockers gradually decreased,the application rate of ACEI / ARB gradually decreased,"Golden Triangle" Drug Application guideline adherene index is worse.