The EXCEL Study: Long-term Observation of the Effectiveness of Drug and Non-drug Rehabilitation in Patients with Ischemic Heart Failure.

AIM: To study the long-term effect of enhanced external counterpulsation (EECP) therapy on exercise tolerance, quality of life (QoL), and indicators of the structural and functional state of the cardiovascular system in patients with stable ischemic heart disease (IHD) complicated by chronic heart failure (CHF). MATERIAL AND METHODS: This open randomized EXCEL study included 120 patients with verified IHD complicated by NYHA II-III functional class CHF with reduced or mid-range left ventricular (LV) ejection fraction. Patients were randomized into group 1 (n=40), optimal drug therapy (ODT) and EECP (35 hours, 2 courses per year); group 2 (n=40), ODT and EECP (35 hours, 1 course per year); and group 3 (control; n=40), ODT and placebo counterpulsation (35 h, 1 course per year). All patients underwent a 6-minute walk test (6MWT), evaluation of clinical status, QoL with the MLHFQ and SF-36 questionnaires, structural and functional state of large blood vessels and microvasculature, measurement of brain natriuretic peptide precursor (NT-proBNP), and echocardiography at baseline and after 12 months. RESULTS: In groups 1 and 2 after 12 months, the 6MWT distance increased statistically significantly (44.5 and 24.9%, respectively) and the following indexes improved: QoL (SF-36, MLHFQ), the condition of large blood vessels (phase shift, radial augmentation index, central aortic systolic pressure (CASP)) and microvasculature (occlusion index, percentage of perfused capillaries, percentage of capillary recovery), and the LV systolic function (from 40.6±7.5 to 47.5±10.2% and from 41.3± 6.8 to 43.9±10.3%, respectively). The proportion of patients with a >20% increase in the 6MWT at 12 months was 97.5, 72.5, and 7.7%, respectively. A statistically significant decrease in NT-proBNP was observed in all groups. In group 3, the incidence of hospitalizations for CHF and the risk of the composite endpoint were significantly higher. CONCLUSION: For the 12-month study period, the effects of EECP in patients with IHD complicated by CHF included improvements in exercise tolerance, QoL, vascular and cardiac functional parameters, and a decrease in the incidence of adverse outcomes.

[GENDER AND AGE DIFFERENCES IN THE TREATMENT OF CHRONIC HEART FAILURE AT HOSPITAL OBSERVATIONS STAGE].

Analysis of literature shows that very little data are available on gender differences and age-specific drug use in the treatment of chronic heart failure (CHF). In this work, the character of drug therapy was studied as dependent on the age and sex of patients with CHF under in-hospital observation conditions. Among hospitalized patients with CHF, an important role is played by modern drug therapy. Gender differences were found in respect of therapy with ACE inhibitors, which was used in men more frequently than in women (89 and 78%, respectively, p <0.001). Aldosterone antagonists were used in the treatment of women much less frequently than in men (32.9 and 42%, respectively, p < 0.001). Loop diuretics are more frequently prescribed to men (48 and 40%, respectively, p < 0.001) and thiazide diuretics, to women (38.9 and 27%, respectively, p < 0.001). In older age groups, CHF treatment both in men (p < 0.05) and in women (p < 0.001) is characterized by decreased use of beta-adrenoblockers and increased use of aldosterone antagonists (p < 0.05). In women, older age groups meet increased prescription frequency of ACE inhibitors/ARBs (from 79.1 to 95.3%p < 0.01) and aldosterone antagonists (from 29.3 to 38.2% p < 0.001).

[Gender-related features of risk factors for, and age- and gender-related differences in the severity and genesis of chronic heart failure].

AIM: To analyze the gender-related features of the prevalence of chronic heart failure (CHF) in Azerbaijan and to estimate the detection rate and risk factors of this condition in inpatients on the basis of a retrospective follow-up study. MATERIALS AND METHODS: A total of 1824 case histories of CHF patients admitted with a CHF diagnosis to the Azerbaijan Research Institute of Cardiology in 2013 were analyzed. RESULTS: The prevalence of CHF is 51.4% among the patients admitted to the Azerbaijan Research Institute of Cardiology. The major etiological factors of CHF are ischemic heart disease (IHD) and hypertension in 79.9% of the. There are gender-related differences in the pattern of cardiovascular diseases in the patients with CHF: IHD (prior myocardial infarction) and hypertension are more common in men and women, respectively. The incidence of CHF was 56.8% among the men; it was registered in them 1.3-fold more often than in the women; 41% of the patients with CHF were older than 60 years. CHF with a left ventricular ejection fraction of < 45% was diagnosed in 84% of the patients. Among the patients with CHF and preserved left ventricular ejection fraction, the number of women rose up to 22%, which was twice higher than that for the men. CONCLUSION: Substantial differences were found in the etiology of CHF in men and women, as well as in patients of different ages.

[Gender-specific features of chronic heart failure].

AIM: To estimate the prevalence of chronic heart failure (CHF) in Azerbajan and analyse its gender-specific features in hospital patients based on retrospective observations. MATERIALS AND METHODS: Retrospective analysis included 3614 case histories of the patients admitted to D.M.Abdullaev Research Institute of Cardiology. RESULTS: Overall prevalence of CHF was estimated at 51.4%, lethality at 6%. The main causative factors of CHF were coronary heart disease and arterial hypertension. Marked differences in CHF etiology between men and women of different age were revealed. The prevalence of CHF in men was 56.8% or 1.3 times that in women. 41% of the patients with CHF were above 60 years of age. CHF with left ventricular ejection fraction of less than 45% and with the preserved one was found in 84% and 16% of the patients respectively. The number of women with this variant of CHF amounted to 22% and was 2 times that of men.