Progression of Chronic Heart Failure: Prognostic Criteria and Non-Drug Prevention

Purpose: to study frequency of progression of chronic heart failure (CHF), to develop multifactorial models for evaluation of risk of progression, and measures of non-drug secondary prevention of CHF. Materials and methods. We included in this study 531 patients with functional class (FC) I–III CHF (FC I – n=254, FC II – n=255, FC III – n=22). Examination included clinical-instrumental, clinical-functional, and laboratory (with determination of NT-proBNP concentration) investigations, use of the AUDIT and Morisky Green questionnaires. Results. Rate of CHF progression for 24 months was 11.7 % (FC I – 16.1, FC II – 7.8, FC III – 4.5 %). Irrespective of FC significant factors of CHF progression were history of myocardial infarction, and low adherence to treatment. Additional prognostic criteria of increase of CHF FC I to FC II were age >74 years, excessive body mass, disturbance of carbohydrate metabolism, arterial hypertension, and frequent intake of alcohol. FC II CHF progression was associated with such factors as type 2 diabetes, 3‑degree arterial hypertension, permanent atrial fibrillation, and smoking. Using these prognostic criteria, we developed multifactor models, based on which scales for assessing the risk of FC I and II CHF progression were created. These models demonstrated high accuracy of prognosis and good reproducibility (on independent test samples of patients with CHF FC I and FC II prognostic accuracy was 86.3 и 85.5 %, respectively). We also developed a program of secondary non-drug prevention of CHF progression, with inclusion of structured dynamic education of patients with organization of control and self-control of knowledge quality. After this therapeutic education progression CHF in high risk patients was 2.2 %. Conclusion. Complex application of scores for evaluation of risk of FC I–II CHF progression and the program of secondary non-drug prevention determined lowering of frequency of increases of class of CHF severity from 11.7 to 2.2 %.

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Treatment optimisation in patients with functional Class II chronic heart failure and arterial hypertension

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2012-2-29-34 ◽

2012 ◽

Vol 11 (2) ◽

pp. 29-34

Author(s):

S. G. Kanorskyi ◽

V. G. Tregubov ◽

V. M. Pokrovskyi ◽

N. A. Bulozhenko

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Arterial Hypertension ◽

Left Ventricular ◽

Functional Class ◽

Stage Ii ◽

Metoprolol Succinate ◽

Nyha Classification ◽

Group I ◽

Group Ii

Aim.To identify the optimal treatment tactics in patients with Functional Class (FC) II chronic heart failure (CHF) (NYHA classification) and essential arterial hypertension (EAH), via investigating the effects of different medication classes on regulatory and adaptive status (RAS). Material and methods.The study included 100 patients with FC II CHF and Stage II EAH, who were randomised into 2 groups. Group I included 53 patients (mean age 52,9±2,3 years) receiving metoprolol succinate (mean dose 97,3±9,5 mg/d). Group II included 47 patients (mean age 57,5±1,3 years) administered quinapril (mean dose 24,7±6,3 mg/d). At baseline and after 6 months of therapy, the following procedures were performed: treadmill test with VO2max assessment; echocardiography; 24-hour blood pressure monitoring; N-terminal pro-brain natriuretic peptide (NT-proBNP) level measurement; and cardio-respiratory synchronism test. Results.While both medications improved left ventricular (LV) diastolic function, only quinapril demonstrated beneficial effects on LV structure, geometry, and systolic function. Only in Group II, exercise capacity and VO2max increased, RAS improved, and NT-proBNP levels decreased to a greater extent. Conclusion.Quinapril was more effective than metoprolol succinate in the treatment of patients with FC II CHF and Stage II EAH.

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Results of the Ultrasound Study of Intracardial Hemodynamics in Patients with Ischemic Heart Disease in Combination with Arterial Hypertension and Complicated by Chronic Heart Failure 2A and 2B

Galician Medical Journal ◽

10.21802/gmj.2017.3.8 ◽

2017 ◽

Vol 24 (3) ◽

Author(s):

Nina Matsegora ◽

Nataliia Mitasova

Keyword(s):

Heart Failure ◽

Pulmonary Hypertension ◽

Heart Disease ◽

Chronic Heart Failure ◽

Ischemic Heart Disease ◽

Arterial Hypertension ◽

Functional Class ◽

Ischemic Heart ◽

Functional Changes ◽

Ultrasound Study

Objective. To conduct a comprehensive study of patients with ischemic heart disease (IHD) in combination with arterial hypertension (AH) complicated by chronic heart failure (HF) 2A and 2B, by studying parameters of intracardiac hemodynamics considering the pressure in the pulmonary artery.Research results. We examined 120 patients with coronary heart disease in combination with hypertension aged 44 to 90 years old (mean age 72.29 ± 1.66), the majority were men (86.7%). All patients were divided into two groups according to the degree of heart failure: HF 2A - 54 persons, with HF 2B - 66 people. The groups were compared in age, gender, functional class of IHD, severity of AH and HF.Analysis of heart ultrasound showed the following. In IHD in combination with hypertension, complicated by HF 2A, the pressure in the pulmonary artery rises in an average to 46.46 ± 3.64 mm Hg and it increases in HF 2B to 57.00 ± 5.19 mm Hg., that corresponding to the average level of pulmonary hypertension (p<0.01); at the same time, the fraction of ejection of left ventricle in the first patients decreases moderately up to 45.96 ± 2.01%, in others - to 39.93 ± 1.99% (p ˂0.01).In patients with IHD in combination with hypertension complicated by chronic heart failure the structural and functional changes are formed on the side of the left heart, accompanied by an increase in their size due to hypertrophy, formation of stagnant phenomena, regurgitation, functional state disorders by the restrictive type, progressive systolic and diastolic dysfunction, increased pressure in the pulmonary artery.Conclusions. Consideration of pulmonary hypertension, along with other parameters of intracardiac hemodynamics, is an important component in determining the degree and nature of heart failure, which requires the selection of adequate and timely therapeutic tactics.

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Clinical traits of chronic heart failure in patients with arterial hypertension and senile asthenia syndrome: an observational cross-sectional study

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2021-28-4-25-40 ◽

2021 ◽

Vol 28 (4) ◽

pp. 25-40

Author(s):

V. A. Safronenko ◽

A. I. Chesnikova ◽

A. V. Safronenko ◽

N. S. Skarzhinskaya ◽

I. I. Kuznetsov ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Arterial Hypertension ◽

Exercise Tolerance ◽

Clinical Symptoms ◽

Functional Class ◽

Clinical Severity ◽

Class Iii ◽

Cross Sectional ◽

Severity Scores

Background. A steady population aging and high incidence of arterial hypertension (AH) lead to a stable increase in chronic heart failure (CHF). The rate of senile asthenia syndrome (SAS) rises in people aged over 80 years and becomes an independent factor of cardiovascular complications.Objectives. The identification of risk factors (RF), comorbidity and clinical symptoms in elderly patients with CHF, AH and SAS.Methods. The study covered 161 AH and CHF patients aged over 80 years. Cohort 1 contained “frailty” patients with AH, CHF and SAS, cohort 2 — “strong” patients with AH, CHF but no SAS. RF, concomitant pathology, clinical symptoms and six-minute walk test were evaluated in all patients. Statistical analyses were performed with Statistica 12.0.Results. Cohort 1 had a higher incidence of atrial fibrillation (AF) (p = 0.001) and chronic kidney disease (CKD) (p = 0.036) compared to cohort 2. Frailty women revealed a higher AF incidence vs. frailty men (p = 0.0002). No-SAS patients had statistically significantly higher body mass index (BMI) (p = 0.047) and obese proportion (by 13.8%). Cohort 1 contained a significantly higher CHF FC III (functional class III), and cohort 2 — CHF FC II rate (p = 0.041). CHF FC III was significantly more frequent in frailty women, and CHF FC II — in frailty men (p = 0.018). Cohort 1 had higher clinical severity scores and a lower exercise tolerance compared to cohort 2 (p < 0.001).Conclusion. Patients with CHF and SAS had a more frequent comorbidity with AF and CKD, greater number of comorbidities and a significantly higher CHF FC III rate, especially in women. Frailty patients showed a greater CHF severity and lower exercise tolerance compared to noSAS individuals.

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FUNCTIONAL CLASSES AND CLINICAL CHARACTERISTICS OF CHRONIC HEART FAILURE IN PATIENTS WITH ATRIAL FIBRILLATION AND/OR FLUTTER AFTER RADIOFREQUENCY ABLATION

The Journal of V. N. Karazin Kharkiv National University, Series "Medicine" ◽

10.26565/2313-6693-2018-35-11 ◽

2018 ◽

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Radiofrequency Ablation ◽

Chronic Heart Failure ◽

Ischemic Heart Disease ◽

Arterial Hypertension ◽

Diabetes Mellitus Type 1 ◽

Functional Class ◽

Ischemic Heart

The combination of atrial fibrillation and/or flutter and chronic heart failure is a frequent problem for many patients. Radiofrequency ablation is effective in the strategy for controlling the rhythm of patients with atrial fibrillation and/or flutter, but always requires concomitant therapeutic support. The study involved 70 patients with atrial fibrillation and/or flutter after radiofrequency ablation which were divided into groups according to the functional class of chronic heart failure. Gender and age of patients; types of ischemic heart disease; stages of chronic heart failure; degrees of arterial hypertension; the form of atrial fibrillation and flutter; class EHRA; the presence of diabetes mellitus type 1 or 2 we evaluated. The female sex prevailed in the group of II functional class of chronic heart failure than in I functional class or III functional class. Ischemic heart disease, first of all angina of effort, in patients with III functional class of chronic heart failure was significantly more frequent. In group of III functional class of chronic heart failure there were significantly more patients with 3 degrees of arterial hypertension. Male patients, regardless of functional class of chronic heart failure, more often than females are conducted invasive methods of treatment for atrial fibrillation/flutter. With increasing of functional class of angina the functional class of chronic heart failure is increasing. Among patients II and III functional class of chronic heart failure prevails the arterial hypertension III degree, which may be a predictor of adverse prognosis.

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118 NT-proBNP values and Weber functional class classification in patients with chronic heart failure

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(07)60078-2 ◽

2007 ◽

Vol 6 (1) ◽

pp. 29-29

Author(s):

R FERNANDES ◽

R SOARES ◽

J FELICIANO ◽

J SERRA ◽

A MAMEDE ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Functional Class

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Dissociation Between Improvement in Left Ventricular Performance and Functional Class in Patients With Chronic Heart Failure

Journal of Cardiovascular Pharmacology ◽

10.1097/01.fjc.0000175235.33949.c4 ◽

2005 ◽

Vol 46 (3) ◽

pp. 262-268 ◽

Cited By ~ 5

Author(s):

Pierre V Ennezat ◽

Caroline A Ennezat ◽

Pugazhendhi Vijayaraman ◽

Justine Lachmann ◽

Philippe Asseman ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Left Ventricular ◽

Functional Class ◽

Left Ventricular Performance ◽

Ventricular Performance

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Remote monitoring of chronic heart failure patients: invasive versus non-invasive tools for optimising patient management

Netherlands Heart Journal ◽

10.1007/s12471-019-01342-8 ◽

2019 ◽

Vol 28 (1) ◽

pp. 3-13 ◽

Cited By ~ 5

Author(s):

J. F. Veenis ◽

J. J. Brugts

Keyword(s):

Heart Failure ◽

New York ◽

Chronic Heart Failure ◽

Remote Monitoring ◽

Heart Association ◽

The United States ◽

Pharmacological Therapy ◽

Functional Class ◽

Class Iii ◽

Additional Tool

AbstractExacerbations of chronic heart failure (HF) with the necessity for hospitalisation impact hospital resources significantly. Despite all of the achievements in medical management and non-pharmacological therapy that improve the outcome in HF, new strategies are needed to prevent HF-related hospitalisations by keeping stable HF patients out of the hospital and focusing resources on unstable HF patients. Remote monitoring of these patients could provide the physicians with an additional tool to intervene adequately and promptly. Results of telemonitoring to date are inconsistent, especially those of telemonitoring with traditional non-haemodynamic parameters. Recently, the CardioMEMS device (Abbott Inc., Atlanta, GA, USA), an implantable haemodynamic remote monitoring sensor, has shown promising results in preventing HF-related hospitalisations in chronic HF patients hospitalised in the previous year and in New York Heart Association functional class III in the United States. This review provides an overview of the available evidence on remote monitoring in chronic HF patients and future perspectives for the efficacy and cost-effectiveness of these strategies.

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Development of a diagnostic model focusing on nutritional indicators for frailty classification in people with chronic heart failure

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab080 ◽

2021 ◽

Author(s):

Yiqin Gu ◽

Chaofeng Li ◽

Jing Yan ◽

Guoping Yin ◽

Guilan Lu ◽

...

Keyword(s):

Heart Failure ◽

Folic Acid ◽

Chronic Heart Failure ◽

Nutritional Status ◽

Functional Class ◽

Brier Score ◽

Diagnostic Model ◽

Serum Samples ◽

Frailty Status ◽

C Statistic

Abstract Aims Frailty has a great impact on the quality of life of patients with chronic heart failure (CHF), which needs to be judged in time. To develop a diagnostic model based on nutritional indicators to judge the frailty status of patients with chronic heart failure (Frailty-CHF). Methods and results In the data collection part of this study, questionnaire method and biomedical measurement method were adopted. The trace elements in serum samples were detected by high performance liquid chromatography, chemiluminescence, and inductively coupled plasma mass spectrometry. We used Excel for data consolidation, and then imported the data into R software for modelling. Lasso method was used for variable screening, and Logistics regression fitting model was used after variables were determined. The internal validation of the model was completed by Bootstrap re-sampling. A total of 123 patients were included in this study. After variables’ screening, age, nutritional status-heart failure, New York Heart Association Functional Class (NYHA), micronutrients B12, Ca, folic acid, and Se were included in the model, the c statistic and Brier score of the original model were 0.9697 and 0.0685, respectively. After Bootstrap re-sampling adjustment, the c statistic and Brier score were 0.8503 and 0.1690. Conclusion In this study, a diagnostic model of age, nutritional status-heart failure, NYHA, the micronutrients B12, Ca, folic acid, and Se was established. It could help healthcare professionals better identify the frailty status in patients with CHF.

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