ABSTRACT
Objective To investigate the prevalence and related factors of medicinal therapy in patients with chronic systolic heart failure (CSHF).Methods Data on in-hospital patients with CSHF were studied from 12 hospitals in Hubei province,in 2000 and 2010.Differences on gender and age were calculated and Multivariate Cox regression analysis was performed to determinate the independent risk factors of all-cause mortality.Results (1) 16 681 patients were enrolled in this study.Among which,6453 died during the 5.82 ± 1.63 years of follow-up.The annual medical expenditure was larger in the survival group than in the dead ones (3.19 ± 0.65 vs.3.32 ± 0.57,P＜0.01).(2)The prevalence of Angiotensin Ⅱ receptor blocker increased along with age which accounted as 7.73％,7.35％,12.26％,14.29％,17.19％,19.87％ and 20.49％,respectively,in the ＜30,30-39,40-49,50-59,60-69,70-79 and ≥80-year groups.The distribution of digitalis,diuretics,β-receptor blocker,Angiorensin- converting enzyke inhibitors showed inversed U shape.(3)The annual medical expenditure increased as patients got older,with age groups ＜30,30-39,40-49,50-59,60-69 and 70-79 years old as 2.96 ± 0.70,3.09 ± 0.62,3.15 ± 0.58,3.30 ± 0.59 and 3.25 ±0.58,respectively (P＜0.01).It reduced to the same level as in the 50-59 year-old group.The distribution of annual medical expenditure showed similar pattern in males.However,the trends were only found in patients at 50-59,60-69,70-79 and ≥80 years-old groups in female.Conclusion More attention should be paid to medicinal therapy in patients with CSHF.Medicinal therapy shifted with age and gender,of which females had more adverse trend than in males.
ABSTRACT
Objective To determinate the prognostic value of etiology in patients with chronic systolic heart failure (CSHF).Methods Data of in-hospital patients with CSHF were investigated between 2000 and 2010 from 12 hospitals in Hubei province.All patients were followed up through telephone calls.Univariate and multivariate Cox proportional hazards analyses were then used to explore the differences in the all-cause mortality,heart failure (HF) mortality and sudden cardiac death (SCD) among patients caused by different etiologies.Kaplan-Meier curve were then constructed and Univariate and multivariate Cox regression analyses were used to select demographic and clinical variables in predicting the all-cause mortality,HF mortality and SCD in CSHF patients.Multivariate logistic models and ROC curve were developed with or without the cinfirmed etiology to assess the incremental additive information related to different etiologies.Results (1)Over the median 3 (2-4) years follow-up program,6453 (38.69％) patients died,including 5505 (33.00％) due to HF prognosis and 717 (4.30％) died of SCD.All-cause mortality rates accounted for 34.50％,54.30％,41.48％ and 15.76％,with HF mortality rates as 30.11％,44.95％,36.25％ and 13.10％.SCDs accounted 8.46％,8.45％,9.84％ and 1.05％ in patients with CHD,DCM,HHD and RHD,respectively.(2) Compared with RHD patients,the adjusted HRs for all-cause mortality were 1.554 (1.240 to 1.947;P＜0.001),1.405(1.119 to 1.764;P=0.003) and 1.315(1.147 to 1.467;P=0.005) while the adjusted HRs and 95％CIs for HF mortality were 1.458( 1.213-1.751 ;P＜0.001 ),1.763( 1.448-2.147;P＜0.001 ) and 1.281 ( 1.067-1.537; P=0.008),in patients with CHD,DCM and HHD,respectively.There were no significant differences in CHD (HR 3.345; 95％ CI,1.291 to 8.666; P=0.013 ) or HHD (HR 2.062; 95％CI,0.794 to 5.352; P=0.137 ),while only DCM ( HR 4.764; 95％CI,1.799 to 12.618;P=0.002) remained significant in SCD despite of the multivariate adjustment.(3) Etiology increased the sensitivity and specificity of predicting models for all-cause mortality(AUC 0.839,95％CI,0.832to 0.845 vs.0.776,95％CI,0.768 to 0.784) and HF mortality(AUC 0.814,95％CI,0.806 to 0.822 vs.0.796,95％CI,0.788 to 0.804) but not with SCD (AUC 0.777,95％CI,0.749 to 0.809 vs.0.747,95％CI,0.727 to 0.766).Conclusion CSHF due to CHD,DCM and HHD carried a worse prognosis than that of RHD.Different etiologies provided significant incremental prognostic information beyond readily available clinical variables for all-cause mortality and HF mortality.
ABSTRACT
Objective To study the relationship between the level of uric acid and oxidative stress in patients with chronic systolic heart failure (CSHF). Methods One hundred and nine hospitalized patients from June 2006 to March 2007 were selected. Based on organic heart disease and heart function, they were classified into two groups: CSHF group (81 cases) and control group (28 eases). According to NYHA heart function grade (Ⅱ, Ⅲ, Ⅳ), CSHF group was divided into three subgroups. The plasma concentration of GSH and GSSG was determined by using glutathione reduetase recycling method (GR-DTNB). Redox potential (Eh) was calculated using Nemst equation according to the concentration of reduced and oxidized glutathione. Results There was significant difference between control group and CSHF group in the level of uric acid [(310.54±99.92) μ mol/L vs (499.09±168.04) μ mol/L], P < 0.01. Uric acid had a negative correlation with LVEF (r=-0.247, P=0.026), and a positive correlation with LVED D (r=0.266, P=0.016). The concentration of uric acid had a negative correlation with GSH (r=-0.328,P=0.003), and a positive correlation with GSSG (r=0.244, P=0.028) and Eh (r=0.309, P=0.005). Conclusions The concentration of uric acid increases in CSHF patients and has a correlation with LVEF and LVEDD. It may be a supplementary marker to reflect heart function and the serious degree of CSHF. The concentration of uric acid has a negative correlation with GSH, and a positive correlation with GSSG and the value of Eh. It may be used as an indicator of oxidative stress concerning its metabolic pathway.