Analysis Of TCM Syndromes And Influencing Factors In Patients With Heart Failure In Vulnerable Period Of Readmission Or Death

ObjectiveTo investigate the clinical characteristics,symptoms and treatment status of TCM and Western medicine in patients with heart failure in Guangdong Provincial Hospital of Traditional Chinese Medicine,and to screen the influencing factors of re-hospitalization in vulnerable period of patients with heart failure.MethodsThis study was a retrospective case-control study.Patients with heart failure discharged from hospital of Guangdong Province Hospital of Traditional Chinese Medicine on October 20,2018 and solstice on October 20,2019 were enrolled and divided into case group 1 and control group 1 according to whether they were readmitted or died within 3 months.The medical record system was retrieved,the basic information of patients was collected,and the difference analysis of the two groups was conducted to preliminarily screen the risk factors.Patients in the case group were randomly sampled and included in the study after age and gender matching.Patients’data were further collected according to the influential factors collection table,including vital signs,clinical characteristics,complications,examination results,treatment conditions and TCM syndromes.SPSS25 software was used for statistical analysis,and different difference analysis methods were used for analysis according to the data type and whether it was in line with the normal distribution.Then Spearman correlation test was conducted to study the correlation,and the influencing factors of rehospitalization in vulnerable period of heart failure were screened.Results1.A total of 962 cases of heart failure were collected in this study,accounting for 30.2%of cardiovascular hospitalizations.The probability of readmission within three months was 22.8%,accounting for 67%of readmission within one year.A total of 491 cases were included in the analysis,including 269 males(53 in the vulnerable stage group and 216 in the control group)and 222 females(59 in the vulnerable stage group and 163 in the control group).The mean age of the case group was 74.63±9.77 years old,and the mean length of hospitalization was 7.36±2.73 days.The mean age of the control group was 69.35±12.22,and the mean hospital stay was 6.37±3.08 days.There were statistical differences in age and gender between the two groups.Women may be more likely than men to be readmitted within 3 months,but this was not statistically confirmed(P=0.07).2.After age and gender matching,62 patients were included for further analysis,including 31 patients in the case group and 31 patients in the control group.Study found that patients with heart failure hospitalization for cardiac function level Ⅲ most,cardiac function Ⅲ,Ⅳ accounts for more than 90%,two groups of cardiac function classification statistically difference,cardiac Ⅳ level probability case group was obviously higher than that of control group.Statistical analysis of the two groups of patients showed that systolic blood pressure(SBP),troponin(cTnT),brain natriuretic peptide before discharge(BNP end),and BNP peak were still risk factors for the vulnerable period of heart failure,even for the same age and sex.Patients with relatively high systolic blood pressure and low troponin have better near-term outcomes.Higher BNP before discharge and higher BNP peak during hospitalization were associated with poorer short-term outcomes(P<0.001).There was no significant difference in the duration of disease between the two groups.In addition,the decrease of BNP during hospitalization(35%vs 47%)and the EF value(57 vs 52)were predicted to be related to the short-term prognosis of the vulnerable period,but this was not statistically confirmed(P=0.435).In this study,there was no significant difference between the two groups in the ratio of heart rate at discharge and heart rate on discharge(heart rate%).In terms of other risk factors,diastolic blood pressure(DBP),body temperature,potassium(K+),albumin,Cr,CK-MB,hemoglobin Alc,LDL-C and other related test results were not significant on the mean and difference.3.This study shows that readmission to hospital in vulnerable period of heart failure has no significant correlation with complications.Main complication of hypertension(84%)of the hospitalized patients with heart failure and coronary heart disease(69%),then followed by diabetes(37%),pulmonary infection(37%),history of PCI(37%),atrial fibrillation(32%),chronic kidney disease(21%),acute coronary syndrome(ACS)(19%),respiratory system diseases,including chronic obstructive pulmonary disease(COPD)and respiratory failure)(18%),history of pacemaker implantation(5%).There was no statistical difference in the complications between the two groups(P<0.05).4.In terms of treatment,the most frequently used drugs were antiplatelet/anticoagulant drugs(76%),followed by spironolactone(73%),β-B blockers(65%),ACEI/ARB drugs(39%),digitalis drugs(16%),ventilator use(15%),and ARNI(6%).This study confirmed that ACEI/ARB drugs had a protective effect on readmission in the vulnerable period of heart failure,which was not achieved by lowering blood pressure,and the difference was statistically significant(P=0.037).5.In terms of TCM syndromes,all the patients’ syndromes were based on the evidence of the basic deficiency standard,and the deficiency syndrome was dominated by Qi deficiency,accounting for 65%,and Yang deficiency accounted for 35%.The specific syndromes of deficiency syndrome were related to readmission in the vulnerable period of heart failure,and patients with Yang deficiency syndrome were more likely to be readmission in the vulnerable period of heart failure.In the empirical aspect,phlegm-drinking syndrome was more common than stasis syndrome,and there was no significant difference in the specific syndromes between the two groups.ConclusionThis study introduces the clinical characteristics and diagnosis and treatment status of patients with heart failure in traditional Chinese medicine system.This study advocates early prevention and treatment of vulnerable period of heart failure,routine detection of heart rate,SBP,TNT,BNP and other indicators and active treatment before discharge.In addition,the treatment of heart failure in the real world is still somewhat different from the drugs and dosages recommended by the guidelines or consensus.This research group advocates integrated traditional Chinese and western medicine in the prevention and treatment of vulnerable period of heart failure,and should pay attention to the active treatment of patients with Yang deficiency,early use of ACEI/ARB drugs,and suggest the control of patients’heart rate to improve the prognosis of patients in vulnerable period.