| BackgroundHeart failure is a complex group of clinical syndromes.The main symptoms of the heart failure patient are dyspnea and/or fatigue,which may be accompanied by fluid retention.It can be caused by any structural and/or functional abnormalities of the heart.Whether in developed countries,or in China,the incidence of heart failure is increasing year by year,and the clinical prognosis of heart failure is not better than that of some malignant tumors.With the arrival of the era of evidence-based medicine,the pathophysiology mechanism of the heart failure has undergone a transition from the pattern of "Liquid and sodium retention,hemodynamic abnormalities" to the pattern of "the abnormal activation of the neuroendocrine system".A series of large-scale Randomized Controlled Trial conducted in the late 1980s have updated people's concept of heart failure treatment.The role of neuroendocrine antagonists as a cornerstone in the treatment of chronic heart failure has been recommended by various countries with high level recommendations.Despite the sufficient evidence in evidence-based medicine,the use of neuroendocrine antagonists in China is far from satisfactory.According to a retrospective study of chronic heart failure hospitalized patients in three different periods in China,ACEI and ?-Blockers are used at the rate of 14%and 8.5%in the 1980s,respectively.Whereas in the 2000s,the use of ACEI was 40.4%,and the use of ?-Blockers was 19%.Although there was an increase compared to the 1980s,there was a significant gap between the level of the use by the developed countries over the same period.Even the 2015 China-HF data indicates that,the rates of ACEI,ARB,and ?-Blockers in discharge heart failure patients were 30.1%,24.6%and 50.6%,there is still a gap compared with developed countries.Guideline-guided standardized drug treatment can improve ventricular remodeling and long-term prognosis in patients with heart failure,and can reduce the mortality and hospitalization rate of patients with heart failure.Therefore,the promotion of standardized drug treatment,the establishment and improvement of outpatient follow-up management system for patients with heart failure are imperative.Objective1.To verify the ratio of the use of the neuroendocrine antagonist drugs and the ratio of the use of the drugs reach to the guideline-recommended target dose after standardized drug therapy in patients with chronic heart failure.2.To verify the efficacy and safety of standardized drug therapy and outpatient follow-up management system for ventricular remodeling and prognosis in patients with heart failure.3.To provide basis for the promotion of standardized treatment and outpatient follow-up management system of patients with heart failure in China.Methods1.Collecting patientsPatients with heart failure who were treated at the outpatient department of Professor Ji Xiaoping,Department of Cardiology,Qilu Hospital,Shandong University,were recruited and followed up if the patients met the inclusion criteria.2.Outpatient follow-up managementThe follow-up of all patients was the responsibility of the individual and the patient was contacted by telephone on a regular basis.Each patient has a follow-up file.Each follow-up information was entered by an individual into an electronic follow-up form that was designed in advance.Treatment of neuroendocrine antagonists is initiated at low doses,before the dose of ?-Blockers and the RAAS inhibitors were reaching to the recommended target or maximum tolerable dose according to the guidelines,patients should followed up every 2-4 weeks,providing their symptoms and the self-administered blood pressure and heart rate for the medication adjustment.When the ?-Blockers and RAAS inhibitors are titrated to the target dose or maximum tolerated dose,patients are followed up every 6-12 months to examine the patient's liver and kidney function,blood biochemistry,NT-proBNP and echocardiography.When the patient's neuroendocrine antagonist drug is used at a target dose or maximum tolerable dose,regardless of the patient's LVEF and/or LVEDD return to normal range,patients should stick to current medication.3.Data acquisition and analysisThe basic medical history of the enrolled patients was collected before the initiation of the standardized drug treatment,including:sex,age,vital signs,NYHA heart function classification,heart failure etiology and concomitant diseases.If a patient is an inpatient after discharge come to the clinic,the patient's personal history and past concomitant diseases are determined based on the patient's inpatient medical records;if the patient was first find LVEF reduction in the clinic,and the symptoms of heart failure are not obvious,and has no previous history of hospitalization,considering that the patient's self-reported history may be inaccurate,so we do not count the patient's personal history,past concomitant diseases.The usage and dosage of the drugs adjustment,the blood pressure,the resting heart rate,and the auxiliary examination results were recorded in the patient's outpatient medical records at each follow-up visit.Databases were established and analyzed using SPSS 24.0 According to whether the data met the normal distribution,they were expressed as mean standard deviation(x+s)or median and interquartile range(M,IQR).Paired sample t test and non-parametric test were used to compare the results.Kaplan-Merie survival curves were used for survival analysis.P<0.05 was considered statistically significant.Result1.115 patients completed the follow-up.3 patients had only survival analysis due to incomplete medical records.For the remaining 112 patients,the average age was 51.1 ± 15.1 years,and 64.3%of the male patients,most heart failure's etiology due to cardiomyopathy(58'0%),the median follow-up time was 21.4(11.7-40.8)months.2.?-Blockers and RAAS inhibitors were used in all patients,and the combined rate was 100%.Ratio of ?-Blockers reaching to the target dose is 80.4%and ratio of RASS inhibitors reaching to the target dose is also 80.4%.3.The total mortality in this study was 3.5%(4/115),and the rate of rehospitalization during follow-up was 28.6%(32/112).4.After treatment,the LVEF was significantly improved[(34.2 ±7.2)%vs(46.9 ± 13.4)%,P<0.01)],among which 60 patients(53.6%)recovered to normal(LVEF? 50%)after treatment.5.After treatment,the LVEDD was significantly reduced[(60.7 ± 8.1)m:m vs(56.1 ± 8.6)mm,P<0.01].Among the 96 patients with increased initial LVEDD(male>55mm,female>50mm),there were 29 cases(30.2%)with normalized LVEDD(male?55mm,female?50mm).6.After treatment,the NYHA grading of the patients was significantly lower than before,with grades I to II predominating,accounting for 92.9%.7.During the follow-up period,no patient experienced transient symptoms of hypotension.The incidences of bradycardia,transient hyperkalemia,transient hypokalemia and transient hyponatremia were 6.3%,1.8%,2.7%and 2.7%.ConclusionIn this study,after standardized drug treatment and outpatient follow-up management:most patients achieved the target dose recommended by the guidelines,the drug has good efficacy and safety. |
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