Relevance. Frequent repeated hospitalizations due to acute decompensation of heart failure worsen the prognosis of patients with CHF. This dictates the necessity to set up medical and physical rehabilitation system of effective control after discharge from the hospital at an outpatient stage. The main task of setting up a center for CHF treatment was to develop and refine the system of managing patients with CHF.
Objective. To establish the differences in two strategies for monitoring patients with CHF after acute heart failure decompensation and to determine the efficiency of treatment, rehabilitation methods and life expectancy, depending on monitoring them in the setting of a specialized city center for CHF (CCHF) treatment and in real outpatient practice.
Materials and methods. The study included 648 patients with CHF of any etiology older than 18 years of age. Group 1 comprised 412 patients with CHF who were monitored at the inpatient department of the CCHF with acute heart failure decompensation and after the discharge they continued rehabilitation at the outpatient department of CCHF. Group 2 comprised 236 patients with CHF who were discharged for acute heart failure decompensation from the CCHF and preferred to be monitored in other outpatient clinics in Nizhny Novgorod.
Results. After 1 year of follow-up, group 1 patients became significantly more hemodynamically stable. The overall mortality rate in group 1 was 4.13 %, and in group 2 – 14.83 % (OR = 4.0, 95 % CI: 2.2-7.4, p <0.001). Mortality from cardiovascular causes is significantly higher in group 2: 11.4 % compared to 3.3 % in group 1 (OR = 3.8, 95 % CI: 2.0-7.4, p < 0.001), as well as mortality from acute heart failure decompensation: 7.6 % vs. 2.1 % of cases (OR = 3.8, 95 % CI: 1.7-8.7, p <0.001). Nonfatal cardiovascular complications were registered significantly more rarely in group 1 than in group 2: 1.6 % vs 5.1 % (OR = 3.2, 95 % CI: 1.2-8.3, p = 0.01). In group 2, the incidence of fatal and nonfatal strokes and thromboembolic complications was significantly higher - 6.3 % compared to 1.4 % of cases in group 1 (OR = 4.4, 95 % CI: 1.7-11.6, p < 0.001). An increase in the proportion of re-hospitalized patients with CHF during the year was recorded in group 2 compared to group 1: 50.3 % and 31.8 % of patients (OR = 2.2, 95 % CI: 1.5-3, 2, p <0.001). The physical activity of patients who were observed in the department of the CCHF was significantly higher than among patients who were treated in other outpatient clinics in Nizhny Novgorod.
Conclusion. The introduction of the system of managing patients with CHF after an episode of acute heart failure decompensation turned out to be significantly more effective in comparison with the generally accepted approach. Managing patients with CHF after hospitalization for acute heart failure decompensation requires active continuous titration of basic drugs, physical rehabilitation, as well as training the patient to control his condition, which is possible only due to “patient schools”, maintaining a close contact between the doctor, nurse and patient and a stable schedule of examinations and phone calls.2018 Том 2, №1