[Patients after acute decompensation of Heart Failure: adherence to self-monitoring and treatment depending on the mode of outpatient monitoring].

Aim      To evaluate compliance with self-monitoring and drug and non-drug treatment of patients after ADHF during the management at a specialized center for CHF treatment (CCHF) or in real-life clinical practice.Material and methods  The study included 942 CHF patients after ADHF. In two years, the entire sample of patients was retrospectively divided into 4 groups based on their compliance with the management at the CCHF: group 1, 313 patients who were managed at the CCHF continuously for two years; group 2, 383 patients who choose the management at district outpatient clinics after discharge from a hospital; group 3, 197 patients who visited the CCHF for one year but then stopped the management; and group 4, 49 patients who initially preferred the management at district clinics but then switched to constant management at the CCHF. Compliance with recommendations was analyzed by data of outpatient clinical records or by data of structured telephone calls for patients who did not visit the CCHF or did not follow the visit schedule. Statistics was performed with a Statistica 7.0 for Windows software package.Results Patients of groups 2 (72.4 %) and 3 (88.3 %) performed self-monitoring less frequently whereas patients of groups 1 (94.6 %) and 4 (87.8 %) performed self-monitoring more frequently (р1 / 3=0.01, р1 / 2<0.001, р1 / 4=0.07, р2 / 4=0.02, р2 / 3<0.001, р4 / 3=0.9). Patients of group 2 (58.1 %) performed self-monitoring of heart rate less frequently than patients of groups 1, 3, and 4 (90.7 %, 81.7 %, and 87.8 %; р1 / 3=0.003, р1 / 2<0.001, р1 / 4=0.5, р2 / 4<0.001, р2 / 3<0.001, and р4 / 3=0.3). Patients of group 2 performed body weight self-monitoring less frequently than patients of groups 1, 3, and 4 (78.6 %, 67.9 %, and 72.9 %; р1 / 3=0.008, р1 / 2<0.001, р1 / 4=0.4, р2 / 4=0.002, р2 / 3<0.001, and р4 / 3=0.5). Compliance with the diet and restriction of salt consumption was 32.3 % and 37.5 % in groups 1 and 4, and 24.9 % and 19.9 % in groups 2 and 3 (р1 / 3=0.002, р1 / 2=0.03, р1 / 4=0.5, р2 / 4=0.02, р2 / 3=0.2, and р4 / 3=0.009). Compliance with recommendations on physical rehabilitation was 44.7% in group 1, which was better than in groups 2, 3, and 4 (8.2 %, 21.6 %, and 9.1 %; р1 / 2<0.001, р1 / 3=0.0003, р1 / 4=0.002, р2 / 4=0.9, р2 / 3=0.0006, and р4 / 3=0.2). At the end of the second year of follow-up, the actual proportion of patients taking ACE inhibitors/angiotensin receptor antagonists was low in groups 2, 3, and 4 (43.2 %, 45 %, and 66.7 %) and satisfactory in group 1 (92.4 %; р1 / 2<0.001, р1 / 3<0.001, р1 / 4<0.001, р2 / 3=0.6, р2 / 4=0.05, and р3 / 4=0.05). Proportion of patients taking beta-blockers was greater in group 1 (97.2 %) than in groups 2, 3. and 4 (73.2 %, 71.1 %, and 90.5 %; р1 / 2<0.001, р1 / 3<0.001, р1 / 4=00.08, р2 / 3=0.6, р2 / 4=0.1, and р3 / 4=0.06). Patients of group 1 (96.2 %) showed good compliance with the mineralocorticoid receptor antagonist treatment compared to groups 2, 3, and 4 (58.8 %, 55.4 %, and 81.2 %; р1 / 2<0.001, р1 / 3<0.001, р1 / 4<0.001, р2 / 3=0.5, р2 / 4=0.1, and р3 / 4=0.Conclusion      Only scheduled management by a cardiologist of the specialized CCHF provided sufficient compliance with self-monitoring and drug and non-drug treatment of CHF during the long-term follow-up.

Correlation of Lipid Profile and Glycated Hemoglobin as a New Prognostic Criterion for Type 2 Diabetes Mellitus Development and Progression.

The aim of the study was to assess correlations between the lipid profile and glycated hemoglobin in order to define their prognostic value as a criterion for the development and progression of type 2 diabetes mellitus (DM2) in individuals with metabolic syndrome and low body mass. MATERIALS AND METHODS: The study included the results of examining 50 patients with metabolic syndrome (group 1), 50 with low body mass index (BMI) (group 2), 50 with DM2 (group 3), and 50 apparently healthy people (control group). Biochemical indices of the lipid profile and glycated hemoglobin in the venous blood were assessed using analyzers Clima MC-15 (Spain), BS-200, and BS-200 E (China). RESULTS: It has been established that correlations of the parameters such as high-density lipoproteins (HDL), low-density lipoproteins (LDL), urea, and creatinine with BMI are expressed statistically more significantly in women in groups 1 and 2 in comparison with group 3, while in men the reverse situation is observed. Besides, correlation of triglyceride levels with BMI is statistically more marked in patients with DM2 than in apparently healthy people being positive in women and negative in men.Thus, HDL, LDL, creatinine, and urea may be diagnostically significant in the assessment of the development and progression of DM2 in men with metabolic syndrome since a strong positive correlation has been found between them and BMI, triglycerides were also found to be significant because a strong negative correlation has been detected between them and BMI.For women with metabolic syndrome, the combination of a weak correlation of BMI with the levels of HDL, LDL, urea, and creatinine and a strong positive correlation with triglycerides may be considered to be a prognostically significant index. CONCLUSION: New correlation characteristics of biochemical blood indices in DM2 may serve as prognostic criteria for disease development and progression.

Predictors of community-acquired pneumonia in patients with acute decompensated heart failure: the results of the analysis of the hospital sample EPOHA-D-CHF.

AIM: Identify the most significant predictors of community-acquired pneumonia and their im-pact on the risk of this disease in patients with ADHF. MATERIALS AND METHODS: The analysis of the hospital sample of patients (n=852) with ADHF. In 16.5% of hospitalizations, community-acquired pneumonia was found. RESULTS: The presence of symmetrical rales in the lungs, hepatomegaly, left ventricular failure signs, dilated cardiomyopathy, hypotension are increasing the risk of pneumonia in 3.7 (p<0.001), 1.6 (p=0.02), 1.86 (p=0.005), 1.72 (p=0.002), 2.7 (p=0.003) times. CONCLUSION: Based on results of a single and multivariate regression analysis, the risk of pneumonia is statistically significant increase in patients with acute left ventricular failure, dilated cardiomyopathy, hypotension, with signs of stagnation in the small and large circulatory circles. Different combinations of these predictors were found in 80% of patients with ADHF, among which in 20% of cases there was a combination of 3-5 factors.