Retrospective Analysis Of Standardized Treatment Of Chronic Heart Failure In The Real World

BackgroundHeart Failure（HF）is the final stage of various heart diseases.It has the characteristics of high morbidity,high mortality,high rehospitalization rate and low quality of life,and has become a serious public health problem in the world.With the development of the global aging trend,the incidence and prevalence of heart failure increase year by year,which brings heavy burden to the social economy.Coronary heart disease is the most common cause of heart failure in our country,followed by hypertension.Infection was the leading cause of hospitalization in heart failure,followed by Arrhythmia,electrolyte disturbance and so on.A large amount of evidence-based medical evidence has proved that standardized treatment of heart failure based on ACEI/ARB,β receptor blocker and aldosterone receptor antagonist can reduce the rehospitalization rate,mortality rate,improve the quality of life and benefit the long-term prognosis.Other studies have shown that age,gender,NYHA cardiac function grade,LVEF,NT Pro BNP,albumin,blood potassium,adherence to standardized drug treatment outside the hospital and other factors affect the rehospitalization rate or mortality of heart failure;age,NYHA cardiac function grade,acute heart failure attack,PCI operation,length of hospital stay,use of βreceptor blockers and other factors affect the hospitalization expenses of patients with heart failure.Previous studies on standardized treatment and influencing factors of readmission rate and mortality in patients with chronic heart failure have focused on tertiary hospitals,less involved in primary hospitals,and the primary hospital is the main battlefield of heart failure treatment.After the patients with severe,complex and difficult heart failure are clearly diagnosed and treated in the tertiary hospital,most of them are transferred to the primary hospital,and the treatment of heart failure in these hospitals directly affects whether the treatment effect of heart failure in the tertiary hospital can be effectively maintained.In the real world,what is the status of standardized treatment of heart failure in primary hospitals?What are the factors that influence the outcome of heart failure patients during hospitalization?What factors lead to repeated hospitalizations in patients with heart failure?What factors are associated with hospitalization costs?Based on solving the above problems,the design idea of this study is formed.Objectives1.Epidemiology and drug treatment status of inpatients with chronic heart failure in primary hospitals;2.To analyze the influencing factors of the prognosis of chronic heart failure patients during hospitalization in primary hospitals;3.To explore the factors influencing the rehospitalization and the interval of hospitalization in patients with chronic heart failure;4.To explore the influencing factors of hospitalization expenses in patients with chronic heart failure.Subjects and methodsIn this study,339 patients with chronic heart failure diagnosed by the New York Heart Association（NYHA）were retrospectively case-control study from June 2012 to July 2018 at the Central District People’s Hospital in Zaozhuang.The diagnosis and treatment of heart failure are based on the Chinese guidelines for the diagnosis and treatment of heart failure 2014.Through the inpatient case system to retrieve cases and review the paper cases,to collect relevant clinical data,it includes patient name,sex,age,time of admission,time of discharge,predisposing factors of admission,history,diagnosis of discharge,results of laboratory examination,electrocardiogram,echocardiography,imaging examination,drug use,treatment outcome,hospitalization expenses,time interval of readmission,etc.SPSS20.0 system analysis software was used for analysis.Results1.In this study,339 patients with chronic heart failure,154 males and 185 females,were selected.Their ages ranged from 29 to 93 years with an average age of 68.62±13.38 years.Among them,73 patients aged ≤60 years（21.53%）,130 patients aged 60～75 years（38.35%）,and 136 patients aged ≥75 years（40.12%）.2.Etiological composition of heart failure,Coronary heart disease accounted for 65.2%,Dilated cardiomyopathy 14.5%,rheumatic valvular heart disease 9.4%,hypertensive heart disease 6.8%,and other causes 4.1%.3.The risk factors of heart failure were infection（31.6%）,sodium and water retention（13.6%）,arrhythmia（11.5%）,myocardial ischemia（6.8%）,electrolyte disturbance（4.7%）,mood swings（2.4%）and other（29.5%）.4.Percentage of patients with chronic heart failure using medication during hospitalization:ACEI or ARB drugs 53.4%,receptor blocker 35.4%,diuretic 95.9%,spironolactone 95.9%,digoxin 87.3%,cedilanem 62.2%,nitrates 63.1%,aspirin 92.6%,statins,63.7%.5.Influencing factors on the prognosis of patients with chronic heart failure during hospitalization:Pulmonary infection（OR=4.799,95%CI:1.156～19.919,P<0.05）,low admission systolic blood pressure（OR=0.977,95%CI:0.972～0.981,P<0.05）,low albumin（OR=0.910,95%CI:0.891～0.928,P<0.05）,elevated aspartate aminotransferase（OR=1.003,95%CI:1.000～1.006,P<0.05）,dobutamine（OR=9.173,95%CI:1.351～62.272,P<0.05）were the risk factors affecting the outcome;β receptor blockers（OR=0.202,95%CI:0.046～0.898,P<0.05）,spironolactone（OR=0.125,95%CI:0.066～0.235,P<0.05）and statins（OR=0.307,95%CI:0.121～0.779,P<0.05）were protective factors affecting the outcome of patients.6.Influencing factors of repeated hospitalization in patients with chronic heart failure:increased heart rate（OR=1.003,95%CI:1.001～1.005,P<0.05）,elevated blood urea nitrogen（OR=1.075,95%CI:1.032～1.121,P<0.05）and drug application of spironolactone（OR=1.757,95%CI:1.227～2.516,P<0.05）were the risk factors affecting repeated admission;Nitrates（OR=0.582,95%CI:0.373～0.907,P<0.05）were used to reduce the number of repeated admission.7.To analyze the influencing factors of hospitalization expenses in patients with chronic heart failure:Pleural effusion（OR=1.514,95%CI:0.999～2.293,P<0.10）,elevated blood glucose（OR=1.209,95%CI:1.092～1.340,P<0.05）,elevated alanine aminotransferase（OR=1.002,95%CI:1.000～1.005,P<0.10）,decreased blood potassium（OR=0.732,95%CI:0.621～0.864,P<0.05）,and the use of milrinone（OR=9.000,95%CI:2.088～38.787,P<0.05）increased the hospitalization expenses of patients.8.Influencing factors of readmission interval in patients with chronic heart failure:Pleural effusion（OR=0.441,95%CI:0.242～0.807,P<0.05）,elevated blood glucose（OR=0.810,95%CI:0.702～0.934,P<0.05）and decreased prealbumin（OR=1.005,95%CI:1.001～1.009,P<0.05）could shorten the time interval of readmission in patients with chronic heart failure;Dihydropyridine CCB（OR=4.215,95%CI:1.156～15.371,P<0.05）was used to prolong the time interval of readmission in patients with heart failure.Conclusions1.The incidence of chronic heart failure in primary hospitals gradually increased with the increase of age;The etiological diagnosis of coronary heart disease was the first in hospitalized patients;Hospital admission predisposing factor infection was the first.which was consistent with the guideline;2.The treatment of heart failure in primary hospitals still focuses on strengthening heart,diuresis and vasodilation,which is far from the standardized treatment scheme of heart failure based on neuroendocrine antagonists required by the guidelines;3.Application β receptor blockers and spironolactone can improve the prognosis of hospitalized patients with heart failure;Systolic blood pressure and nutritional status affect the prognosis of patients with heart failure;Controlling heart rate can reduce the number of repeated hospitalizations in patients with heart failure;Poor nutritional status,high blood glucose and pleural effusion shorten the time interval of readmission;Hypokalemia,elevated blood glucose and pleural effusion increase the hospitalization expenses of patients with heart failure.