Retrospective Study On The Optimization Of MUSIC Score For Heart Failure Based On TCM Syndrome Types

Purpose:To explore the influencing factors of the prognosis of patients with heart failure based on the theory of traditional Chinese medicine combined with modern medicine,optimize the MUSIC risk score of heart failure,to improve the ability to predict the prognosis risk of heart failure,and to provide the basis for the early intervention and treatment of the heart failure of the integrated traditional Chinese and Western medicine.Data and Method: To collect the information of patients with heart failure who were hospitalized in cardiology from January 2019 to December 2019 of the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine.The collected data include the general situation,past history,laboratory examination,auxiliary examination,cardiac function classification,TCM syndrome type and outcome events.The follow-up time was 6 months.The end-point outcome was determined by the electronic medical record and telephone inquiry.The end-point outcome included hospitalization due to heart failure and all-cause death.The end-point ending without occurrence is non event group,and the ending result is called event group.Firstly,the single factor analysis method was used to screen the possible factors of prognosis,then the factors influencing the prognosis screened were stepwisely analyzed by binary logistic regression analysis to obtain the factors of the influencing the prognosis,and finally,the optimization of MUSIC score was evaluated by receiver operating characteristic(ROC)curve and area under curve(AUC).Results:1.The correlation between TCM syndrome type and cardiac function classification was analyzed by Kruskal Wallis test.The 2 value was 126.59(P = 0.000 < 0.05),indicating that the heart function classification was from high to low,and the distribution of TCM syndrome type was as follows: Yang deficiency blood stasis or phlegm drink syndrome,Qi Yin deficiency blood stasis or phlegm drink syndrome,Qi deficiency blood stasis or phlegm drink syndrome meaning that it existed the correlation between TCM syndrome type and cardiac function classification.2.The results of the single factor analysis showed that the P value of the atrial fibrillation,pulmonary infection,NT-pro BNP,C reactive protein,cardiac troponin I,TCM syndrome type,cardiac function grade and MUSIC score was less than 0.05 having the statistical significance.The 8 indicators screened out that may affect the prognosis of heart failure via the above univariate analysis were further analyzed by the multivariate binary stepwise logistic regression.The results showed that the P value of the TCM syndrome type,cardiac function classification,NT pro BNP,C-reactive protein and Music score were less than 0.05,OR more than 1 The above multivariate analysis finally screened out 5 factors that affected the prognosis of patients with heart failure.3.ROC curve results showed that the AUC of TCM syndrome type,C reactive protein and cardiac function score combined with MUSIC score was 0.776;AUC of MUSIC score was0.744;AUC of C reactive protein was 0.629;AUC of cardiac function classification was0.652;AUC of TCM syndrome type was 0.621.The AUC of influence factor combined MUSIC score was higher than that of single MUSIC score.Conclusion:1.There existed the correlation between TCM syndrome type and heart function classification.With the increase of the classification of cardiac function,the distribution of TCM syndrome type was as follows: Qi deficiency blood stasis or phlegm drink syndrome,Qi Yin deficiency blood stasis or phlegm drink syndrome,Yang deficiency blood stasis or phlegm drink syndrome.To a certain extent,the TCM syndrome type of the heart failure can roughly correspond to the heart function classification,to judge the development of the heart failure.2.The TCM syndrome type,cardiac function classification,NT-pro BNP and C-reactive protein were the main factors influencing the prognosis of the heart failure.3.The predictive ability of TCM syndrome type,cardiac function classification and C-reactive protein combined with MUSIC score was better than MUSIC score.