Prognosis of the life of patients with chronic heart failure and atrial fibrilla-tion, depending on the control of hemodynamic parameters and tolerance to physical exertion in the background of basic therapy

Abstract

Actuality. In the basic therapy of CHF, drugs that reduce the pulse is one of the leading places. Target values of heart rate with sinus rhythm are established. Tere is still no consensus as to which heart rate is ideal in patients with CHF on the background of the rhythm of atrial fbrillation (AF). Te study of the prognosis in patients with CHF and AF depending on the achieved heart rate is relevant.Objective. To analyze the overall mortality and establish the stratifcation risks of death in patients with CHF and AF depending on the form of AF, functional class of CHF and the presence of tachycardia.Material and methods. A prospective cohort study was conducted in a group of patients with CHF who were observed at the City Center for CHF treatment (n = 591) during the year. Of these, 47.4% of patients had CHF and AF (n = 280) and 52.6% of patients with CHF without AF (n = 311).Results. In a year, a permanent AF registered among patients with CHF and AF in 55.4%, persistent – in 36.4%, and paroxysmal – in 8.2% of cases. In 12.2% of patients, the diagnosis of AF was frst diagnosed. According to functional class of CHF, LVEF, assessment of clinical assessment scale, the group with a permanent AF was signifcantly heavier than without AF. Te mortality of patients with tachycardia signifcantly increased as a function of the increase in CHF from I–II to III–IV class: from 3.6% to 14.9% in the group without AF (p=0.04), and in the group with paroxysmal and persistent AF from 6.7% to 25.9% (p = 0.043). Te presence of tachycardia increases the risk of death by 61%, and the transition to a heavier functional class is 4.9 times. With each increase in the clinical assessment scale exponent by 1 point, the mortality rate in the sample is increased by 16%.Conclusion. Heart rate is not an independent predictor of death, but in combination with functional class III–IV CHF tachycardia signifcantly worsens the prognosis.