Assessment of the Clinical Profile and Approaches to the Diagnosis and Treatment of Patients Hospitalized with Acute Decompensation of Heart Failure

Abstract

INTRODUCTION: Acute decompensation of heart failure (ADHF) is one of the leading diagnoses for hospitalization in therapeutic/cardiologic hospitals worldwide and is associated with a poor prognosis. AIM: To study the prevalence, clinical diagnosis, approaches to diagnosis, and treatment of patients hospitalized for ADHF. MATERIALS AND METHODS: A retrospective analysis of 202 medical records of inpatients hospitalized for ADHF in the first cardiology unit of Regional Clinical Cardiologic Dispensary in 2019 was performed. The clinical and instrumental characteristics of the patients, factors that led to hospitalization, and approaches to the diagnosis and treatment were examined. RESULTS: The prevalence of ADHF was 11.2%, the mean age of the patients was 68.4 10.8 years, and 49.0% were men. The most common causes of ADHF were atrial fibrillation (AF, 31.7%), uncontrolled arterial hypertension (AH, 20.8%), С4С5 stage chronic kidney disease (CKD, 19.4%), and non-adherence of clinical prescriptions (14.4%). Among the most commonly registered etiological factors of chronic heart failure (CHF) were AH (89.6%), AF (67.3%), and coronary heart disease (CHD, 64.9%). The left ventricular ejection fraction (LVEF) was preserved in 48.7% of the patients, intermediate in 21.4%, and reduced in 29.9%. In 2019, in real clinical practice, levels of natriuretic peptides were not determined, and blood electrolytes were not determined often enough (71.8%). The frequency of the administration of angiotensin-converting enzyme (ACE) inhibitor/angiotensin II receptor blockers (ARB-II)/neprilysin receptor antagonists (NRA) and beta-adrenoblockers (BAB) did not depend on the LVEF, which were 84.2% and 76.2%, respectively. Mineralocorticoid receptor antagonists (MCRA) were more commonly used in CHF with low LVEF at 89.2% against 78.7% among all patients (p 0.05). On hospital discharge, ACE inhibitor/ARB-II/NRA therapy was recommended in doses of 21.1%, BAB in 7.6%, and MCRA in 72.0% of target values. CONCLUSIONS: The prevalence of ADHF in all patients hospitalized in Cardiologic Hospital of Ryazan Regional Vascular Center was 11.2%. The most common causes of ADHF in patients with CHF were LVEF and AH, AF, and CHD, and the most frequent factor of CHF decompensation was AF. On hospital discharge, the drugs that improve the prognosis of CHF were prescribed at insufficient doses.