Clinical Characteristics And Prognostic Evaluation Of GWTG-HF Risk Score Joint BNP Of The Elderly Inpatient With Heart Failure In Middle Range Of Ejection Fraction

Purpose:In recent decades the prevalence of heart failure is more and more high,this is a challenge for clinical decision making,and a good risk model can provide the basis for clinical decision making.GWTG-HF as a risk decision model has been widely used in the United States,but whether the model is suitable for the Chinese people remains to be seen,at the same time the elderly as high-risk groups of HF,and many previous studies tend to exclude the elderly,so validation GWTG-HF model is of great significance for the applicability of the Chinese elderly people.Method:To collect on Augest 1st,2018 to June 1st,2020 in the first affiliated hospital of anhui medical university heart medicine conforms to the inclusion and exclusion standard in hospital,426 cases of senile heart failure patients,arrangement and classification of data,analysis of ejection fraction median clinical features in patients with heart failure,and using the subjects operating characteristics(ROC)curve comparison GWTG-HF risk score,the BNP score,GWTG-HF/BNP comprehensive score of prediction accuracy,and using mathematical statistics methods to statistics and inspection.Results :(1)The constituent ratios of three groups are: HFr EF(32.63%),HFmrEF(31.92%),HFp EF(35.45%).(2)Compared with HFr EF group,HFmrEF group for the elderly,systolic blood pressure,heart rate is a little bit higher,(P < 0.05);Coronary heart diseas Hypertension,diabetes,atrial fibrillation proportion is big,big proportion of the cardiac function(NYHA classification)level III,a higher percentage of DCM(P< 0.05);Compared with HFp EF group,small HFmrEF group of mostly male,age,systolic blood pressure on the low side(P < 0.05),with atrial fibrillation,heart function class II ratio are smaller(P < 0.05);A higher percentage of DCM(P <0.05).(3)Laboratory tests: Compared with HFr EF group,HFmrEF group in hemoglobin,blood uric acid,TC,LDL-C,the BNP level no difference(P > 0.05);Compared with HFp EF group,group HFmrEF BNP level is higher(P < 0.05).(4)Echocardiography: Compared with HFr EF group,HFmrEF group of patients with left atrial diameter,left ventricular end-diastolic diameter,left ventricular stroke volume,shortening fraction is lesser,interventricular septum thickness is higher,lower pulmonary artery pressure(P < 0.05);Compared with HFp EF group,left atrium diameter smaller HFmrEF group,lower interventricular septum thickness,left ventricular end-diastolic diameter,left ventricular stroke volume is larger(P < 0.05).(5)Clinical application for the comparison group,ACEI/ARB,Cefuroxime Sammy,spironolactone,the application of trimetazidine proportion between HFp EF and HFr EF group,the difference statistically significant(P < 0.05).(6)HFmrEF group after discharge the risk factors of cardiac events are higher,GTWG-HF high risk score,cardiac function Ⅲ and Ⅳ level high proportion,the BNP on admission,serum creatinine,blood urea nitrogen level is higher,low levels of glomerular filtration rate,the difference statistically significant(P < 0.05).(7)According to GTWG-HF risk score,three groups of patients was divided into high,medium and low three groups,with the increase of grades,the incidence of cardiac events in HFr EF and HFmrEF group events increase,and the high group and the low group with significant difference(P < 0.05).(8)GWTG-HF risk score cardiac events after discharge of the study area under the curve(AUC)was 0.656(95%CI,0.562 to 0.750).On the basis of conventional GWTG-HF score increased b-type natriuretic peptide levels significantly increased the ability to identify(AUC 0.721;95%CI,0.638 to 0.804).Conclusion:Our study confirmed that the HFmrEF and HFr EF HFp EF patients in clinical,biological markers and their differences in the prognosis HFmrEF is likely to be a state of heart failure in the middle,and points out that the BNP level and GWTG-HF risk score in patients with HFmrEF prognostic value.The prediction model has a moderate accuracy,and the evaluation index is relatively simple,for guiding clinical treatment for heart failure patients may have a better guiding significance.