Clinical Characteristics And Implementation Of Guideline Inpatients With Single-center Chronic Heart Failure From 2012 To 2018

Objective:To understand the clinical characteristics,etiology,the degree of integration with the guidelines for patients with chronic heart failure in the Second Medical College of Shanxi Medical University from 2012 to 2018,and the clinical characteristics of patients with heart failure with mid-range ejection fraction.Methods:A total of 1191 patients with chronic heart failure and met the standard of discharge were collected in our hospital.Use our hospital electronic medical record system to query and collect clinical data.Retrospective analysis of 1191 cases patients with etiological changes,baseline data,laboratory examination,complications,treatment characteristics and degree of integration with the guidelines.In addition,study the revascularization of CHF combined with CHD and the anticoagulant therapy of CHF combined with AF patients.According to the hospitalization time,1191 patients with CHF were divided into the first three years group(2012.08.01~2015.07.31)and the last three years group(2015.08.01~2018.07.31).And comparing the two groups of the above index variation.1191 patients with CHF were divided into three groups according to LVEF: HFrEF group(LVEF<40%),HFmrEF group(LVEF40~49%)and HFpEF group(LVEF?50%),and comparing clinical characteristics of the HFmrEF group patients were different from the other two groups.Results:1.The study included 401(51.9%)males and 573(48.1%)females.The age group has the highest proportion of 65 to 79 years old.Most patients were NYHA III to IV.2.The main causes of 1191 CHF were coronary heart disease(434 cases,36.4%),followed by dilated cardiomyopathy(216 cases,18.1%),hypertensive heart disease(214cases,18.0%),rheumatic heart disease(129 cases,10.8%),degenerative valvular heart disease(39 cases,3.3%)and others(159 cases,13.4%).3.The proportion of 1191 in-hospital patients using diuretics,vasodilators,aldosterone receptor antagonists,ACEI/ARB,?-blockers,antiplatelet aggregation drugs,statins,positive inotropic drugs,digitalis,anticoagulants,calcium antagonists,lyophilized recombinant human brain natriuretic peptide(rhBNP),levosimendan and ivabradine were 86.0%,81.5%,76.4%,68.3%,66.0%,58.6%,47.4%,47.3%,42.0%,34.5%,29.4%,10.2%,5.6% and 1.3%,respectively.Mechanical adjuvant therapy,the incidence of revascularization,CRT and ICD were 6.9%,4.4% and 0.3%,respectively.There were 383 cases CHF combined with AF.And the rheumatic heart disease was the main cause,accounting for 27.2%.The application rate of anticoagulant in 383 cases patients was 60.8%,of which the application rate of warfarin was 38.4%,and the application rate of new oral anticoagulant was 6.8%.434 patients with CHF combined with CHD,of which the incidence of revascularization was 17.1%.4.Compared with the previous three years,in the last three years,the males increased,and the blood pressure and heart rate were lower at admission(P<0.05).The incidence of people over 65 years old and the proportion of NYHA IV increased,and the difference was not statistically significant(P>0.05).The firstly cause of CHF was still coronary heart disease.And the proportion of dilated cardiomyopathy was second,and the difference was not statistically significant(P=0.795>0.05).The degenerative valvularity increased,and the difference was statistically significant(P=0.033<0.05).The rate of hyperlipidemia was lower,and the difference was statistically significant(P<0.05).The use of ACEI/ARB,digitalis,vasodilators,antiplatelet drugs decreased in patientswith CHF,but statins,anticoagulants,rhBNP,levosimendan and ivabradine increased,and the difference was statistically significant(P<0.05).The application rate of anticoagulant increased,and the difference was statistically significant(P=0.001<0.05).The application rate of revascularization increased in patients of CHF combined with CHD,and the difference was not statistically significant(P=0.353>0.05).5.In 1191 patients with chronic heart failure,there were 388 cases(32.6%)heart failure with reduced ejection fraction,200 cases(16.8%)heart failure with mid-range ejection fraction and 603cases(50.6%)heart failure with preserved ejection fraction.The three groups differed in multiple clinical data.Compared with the HFrEF group,the HFmrEF group had more atrial fibrillation,pulmonary infection,and pleural effusion.The use rate of calcium antagonists was higher,and the difference was statistically significant(P<0.05).Compared with the HFpEF group,the HFmrEF group was more common in men.The heart function was worse.It was more common in coronary heart disease and dilated cardiomyopathy,and more complicated with pleural effusion.The use rate of ACEI/ARB+?-blocker+ aldosterone receptor antagonists and positive inotropic drugs were high,the difference was statistically significant(P<0.05).Conclusion:1.Our hospital patients with CHF were more men than women.And they were poor cardiac function at admission.2.Coronary heart disease was the main causes of CHF,followed by dilated cardiomyopathy,hypertensive heart disease,rheumatic heart disease,degenerative valvular heart disease and others,successively.3.The drug treatment of CHF patients in our hospital were basically consistent with guideline recommended.But there were a certain gap between“ACEI/ARB+?-blocker+ aldosterone receptor antagonists” therapy,the anticoagulant of AF patients,mechanical adjuvant therapy and treatment guidelines.4.The main causes and medical treatment of CHF patients changed in the three years before and after,but they were basically consistent with guideline recommended.5.The clinical features of the HFmrEF group patients distinguished the HFrEF and HFpEF group,in an intermediate position.