City Center for the Treatment of Chronic Heart Failure: the organiza-tion of work and the effectiveness of treatment of patients with chronic heart failure

Abstract

Actuality.In the Russian Federation, there has been an increase in the number of patients with chronic heart failure (CHF) of the III–IV functional class, who are characterized by frequent development of acute decompensation of СHF and frequent repeated hospitalizations. This dictates the need to create a system of effective control over the conduct of drug therapy and physical rehabilitation after discharge from the hospital at the outpatient stage.Objective:to identify the differences between the two strategies for monitoringatients with CHF after decompensation and to determine the effectiveness of treatment, rehabilitation measures and life prognosis depending on the observation in the system of the specialized City Center for Treatment of CHF (Heart failure clinic) and in real outpatient practice.Materials and methods:The study included 648 patients hospitalized with decompensation in the inpatient unit of the Center for Treatment CHF. Group 1 consisted of 412 patients who, after discharge, continued rehabilitation and follow-up in the outpatient department of the Center for Treatment CHF. Group 2–326 patients who, after discharge, preferred observation in another outpatient departments of Nizhny Novgorod.Results:After 1 year of observation, the overall mortality rate in group 2 was 14.83 %, and in group 1–4.13 %, (odds ratio (OR) = 4.0, 95 % confidence interval (CI) 2.2–7.4; p <0.001). Cardiovascular mortality was also higher in group 2: 11.4 % versus 3.3 % (OR = 3.8, 95 % CI 2.0–7.4; p <0.001), as well as mortality from decompensation: 7.6 % versus 2.1 % (OR = 3.8, 95 % CI 1.7–8.7; p <0.001). In group 2, non-fatal cardiovascular complications were more common: 5.1 % versus 1.6 % (OR = 3.2, 95 % CI 1.2–8.3; p = 0.01), as well as fatal and nonfatal stroke, pulmonary thromboembolism, venous thromboembolic complications – 6.3 % versus 1.4 % (OR = 4.4, 95 % CI 1, 7–11.6; p <0.001). An increase in the proportion of rehospitalized patients with CHF during the year in group 2 compared with group 1 was recorded: 50.3 % and 31.8 % of patients, respectively (OR = 2.2, 95 % CI 1.5–3.2; p<0.001). Physical activity of patients who were observed in Center for Treatment CHF the was significantly higher than among patients who were treated in another outpatient departments.Conclusion:Management of patients with CHF after decompensation in Heart failure clinic showed better results in comparison with the standard approach: the risks of general, cardiovascular mortality and nonfatal cardiovascular complications were statistically significantly lower. Patients with CHF who refused to be seen at Heart failure clinic were more often hospitalized again during the year.