Analysis Of Prognostic Factors Of Elderly Chronic Heart Failure In A Hospital In Shenyang City

Objective:The study aimed to analyze the prognostic factors of elderly patients with chronic systolic heart failure who were hospitalized in one,two,three cardiovascular departments,elderly dry diagnosis department and elderly Chinese medicine department of a third-class hospital in Shenyang city.Based on the research results,it provides theoretical guidance and practical basis for the prevention and treatment of chronic heart failure in the elderly.Methods:Taking January 2015 to June 2016 as the time interval,the hospital registration book of a tertiary hospital in Shenyang city was queried.371 elderly patients with heart failure were selected as research objects based on inclusion and exclusion criteria.they were followed up for one year and divided into two groups according to the prognosis of the patients:the group with good prognosis and the group with poor prognosis.The general data(sex,age,BMI,diabetes,smoking,drinking,etiology,etc.)of the two groups of patients,various laboratory indexes(liver function index,renal function examination,blood sugar index,blood fat index),examination indexes(heart rate,blood pressure index,echocardiographic related indexes),n-terminal pro brain natriuretic peptide(NT-proBNP),new York heart function classification,treatment and drug use were compared and analyzed.Through univariate and multivariate analysis,the prognostic factors of senile heart failure were explored.In the study,all data analysis of the study subjects were processed by SPSS 22.0software,with?=0.05 as the test level,the quantitative data were tested by t test or rank sum test,and the qualitative data were tested by?~2 test.Single factor analysis was used to analyze the influence of various variables on the poor prognosis group.On this basis,we selected indicators with statistically significant differences between the groups for multivariate logistic regression analysis to evaluate the risk factors affecting the prognosis of heart failure.Results:1.Of the subjects a total of 371 people,including 211 men(56.87%),160 female(43.12%);age distribution:60~69 age group of 185 people(49.87%),70~79 group of89 people(23.99%),80~age group of 97 people(26.14%);161 were smokers(43.40%),210(56.60%)non-smokers;drinkers 115 people(31%),256(69%)non drinkers;BMI group:156 light(42.05%),and 117 normal size people(31.54%),overweight 98 people(26.41%).The object of study in 154 people with diabetes mellitus(41.51%)and non diabetes mellitus 217 people(58.49%);dilated cardiomyopathy and 165(44.47%),non dilated cardiomyopathy and 206 normal subjects(55.53%);BUN 108(29.11%),the abnormal increase of 263 people(70.89%);LVEF group 50%~,64 people(17.25%),40%~49%88(23.72%),30%~39%128(34.50%),30%of the 91 people(24.53%).NT-proBNP:2000ng/L and below 191 people(51.48%),more than2000ng/L 180(48.52%);New York classification,grade II 224(60.38%),III(19.95%)level 74,IV grade 73(19.67%);there were 241 ACEI users(64.96%),130(non users35.04%).Compare the 2.of the two groups of patients with blood lipid index,good prognosis group and poor prognosis group(t=-1.003,TC P=0.318),TG(t=0.344,P=0.731),HDL-c(t=-1.682,P=0.096),LDL-c(t=-1.489,P=0.137)were no significant difference;compare the indicators of liver function in the patients of the two groups.AST(z=3.042,P=0.002),TBIL(z=-3.407,P<0.001),the good prognosis group AST index higher,TBIL index lower,the differences were statistically significant.To compare the indexes of renal function in the patients of the two groups,CR(z=-2.829,P=0.005),BUN(z=-2.003,P=0.045)and microalbuminuria(z=-7.435,P<0.001)and poor prognosis group index higher,the difference was statistically significant;to compare the glycemic index of the two groups of patients,FBG(t=-1.205,P=0.231).No statistically significant difference;HbAlc(t=2.545,P=0.012),the difference was statistically significant,the good prognosis group higher;comparison of thyroid function indexes of the two groups of patients,there was no significant difference of FT3,FT4 and TSH levels;to compare other laboratory indexes of the two groups,the two groups had no statistical significance,in the same type of cysteine serum potassium,serum calcium level difference(P>0.05).There was no significant difference in heart rate,blood pressure,LA and LVDd in the two groups.3.The influence of demographic variables on elderly chronic heart failure prognosis,lifestyle factors,BMI and clinical indicators as independent variables,the prognosis is good or bad as the dependent variable,single factor Logistic regression,the age(?~2=76.010,P<0.001),smoking(?~2=14.191,P<0.001),BMI(?~2=9.110,P=0.011),whether or not suffering from dilated cardiomyopathy(?~2=10.763,P=0.001),LVEF(?~2=41.319,P<0.001),NT-proBNP(?~2=15.176,P<0.001),New York classification(?~2=76.751,P<0.001)and ACEI(?~2=12.739,P<0.001)was independently related to these variables and the prognosis in elderly patients with chronic heart failure,and were statistically significant.4.Single factor analysis showed significant variables further regression by multivariate logistic regression model showed that age,smoking,LVEF,NT-proBNP,New York classification,AST and Urine Microprotein are all prognosis of chronic heart failure with independent correlation,and have statistical significance(P<0.05).The 70~79 age group(OR=2.856,1.153~7.072),more than 80 age groups(OR=6.398,2.559~16.000),LVEF 40%~49%(OR=5.674,0.629~51.197),30%~39%(OR=10.175,1.217~85.055),30%(OR=15.146,1.784~128.583),NT-proBNP group(OR=2.683,1.359~5.298),2000pg/ml New York III grade(OR=5.339,2.378~11.984),IV(OR=6.151,2.773~13.644)and smoking patients(OR=2.006,1.047~3.843)are dangerous poor prognostic factors for elderly patients with chronic heart failure.AST(OR=0.986,0.975~0.998)and Urine Microprotein(OR=1.004,1.000~1.008)are significance items for elderly patients with chronic heart failure.Conclusion:1.There were statistical differences in AST,TBIL,CR,BUN,urinary microprotein and HbAlc levels between the group with good prognosis and the group with poor prognosis of chronic heart failure in the elderly.2.Age,smoking status,BMI,dilated cardiomyopathy,LVEF,NT-pro BNP>2000n g/L,New York grade,ACEI usage,AST and urine microprotein are the factors that affect the prognosis of elderly patients with chronic heart failure.3.Age,smoking,LVEF,NT-pro BNP,and New York rank are independent risk factors for poor prognosis in elderly patients with chronic heart failure.