Aim. To identify risk factors of decompensation of chronic heart failure (CHF) and related hospitalization in elderly outpatients. Material and methods. The total of 248 patients aged 60-85 years with CHF NYHA class II-IV were enrolled into the study. The first group consisted of 87 (35.1%) patients who required hospitalization due to CHF decompensation during the follow-up, the second group -of 161 patients without need for hospital admission. All the patients had undergone clinical and laboratory examination, estimation of CHF severity by the Scale of clinical state, assessment of quality of life and 6-minute walk test (6MWT), echocardiography. Results. Patients were matched for age, gender, disability occurrence, education level, body mass index, quality of life, hemodynamic parameters, incidence rates of anemia, diabetes mellitus and atrial fibrillation. CHF was more severe in patients who had required hospitalization (p<0.001), they were more often diagnosed with left ventricular aneurysm (p=0.001), chronic kidney disease (p=0.001), left ventricular ejection fraction (LVEF)<35% (p<0.001), history of stroke (p<0.001), III-IV degree mitral regurgitation (p=0.007), hyperuricemia (p<0.001), lower exercise tolerance (p=0.007) compared with patients without hospitalization. Higher functional class of CHF (OR=0.29; 95% CI 0.13-0.69; p=0.003), LVEF<35% (OR 0.37; 95% CI 0.18-0.76; p=0.007), chronic kidney disease (OR=0.29; 95% CI 0.13-0.68; p=0.004) and hyperuricemia (OR=0.23; 95%CI 0.10-0.50; p<0.001) were shown to be independent risk factors of CHF decompensation that required hospital admission in elderly patients. Conclusuion. High FC of CHF, low LVEF, hyperuricemia and renal dysfunction play a key role in CHF decompensation and related hospitalization in elderly patients. Key words: chronic heart failure, hospitalization, elderly patients. Цель. Выявить факторы, повышающие риск декомпенсации хронической сердечной недостаточности (ХСН) и связанных с ней госпитализаций у пожилых больных, наблюдаю-щихся в поликлинических условиях. Материал и методы. В исследование были включены 248 больных в возрасте от 60 до 85 лет с ХСН II-IV функционального класса (ФК) по NYHA. Первую группу составили 87 (35,1%) больных, которым в процессе наблюдения потребовалась госпитализация в связи с декомпенсацией ХСН, вторую группу составил 161 больной, не нуждавшийся в ней. Всем больным проводили клинико-лабораторное обследование, оценивали тяжесть ХСН по шкале оценки клинических состояний, качество жизни, осуществляли тест с 6-минутной ходьбой, эхокардиографию. Результаты. Больные двух групп были сопоставимы по возрасту, полу, наличию инвалидности, уровню образования, индексу массы тела, качеству жизни, гемодинамическим по-казателям, частоте встречаемости анемии, сахарного диабета и фибрилляции предсердий. Течение ХСН было более тяжёлое у больных, которым потребовалась госпитализация (р<0,001), у них чаще выявлялись аневризма левого желудочка (ЛЖ) (р=0,001), хроническая болезнь почек (ХБП) (р=0,001), фракция выброса левого желудочка (Ф...
The article discusses modern approaches and features of management, as well as predicting the risk of complications in patients with cardiac arrhythmias, in particular, atrial fibrillation, and the potential of using conservative and interventional treatment methods for heart failure (HF), taking into account updates and achievements in clinical practice. Epidemiological data, algorithms for managing patients with HF and atrial fibrillation, prevention of thromboembolic events, results of studies comparing the effectiveness of different strategies for atrial fibrillation treatment, catheter ablation compared with drug therapy in patients with HF are presented.
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