Study Of Chinese Medical Evidence And Its Prognostic Correlates In Elderly Heart Failure Patients With Preserved Ejection Fraction

Objective: By studying the distribution characteristics of TCM evidence types in elderly patients with heart failure with preserved ejection fraction(HFpEF),we explored the correlation between different TCM evidence types and endpoint events in HFpEF patients,and screened risk factors affecting the prognosis of HFpEF to guide the risk stratification and treatment of elderly HFpEF patients.Methods: A retrospective cohort study was used to include 203 cases of HFpEF patients(age ≥65 years old)hospitalized in the 960 th Hospital of the People’s Liberation Army from December 2020 to June 2022,and followup was carried out for 6 months or more.According to the dialectical typing of traditional Chinese medicine,the patients included in the study are divided into three basic types of Qi deficiency and blood stasis syndrome,Qi Yin deficiency and blood stasis syndrome,and Yang Qi deficiency and blood stasis syndrome.Collect clinical data of patients,including general data,Chinese medicine evidence types,molecular biological indicators and other content.SPSS 21.0 was used to analyze the clinical data of patients,and Cox regression was used to explore the correlation between different Chinese medicine syndrome types of HFpEF and markers of myocardial injury,and the risk factors affecting allcause death and cardiovascular death outcome events were analyzed.Results: 1.Among the 1.203 patients with HFpEF,157 were men and 40 were women,aged 65-101(87.3±8.9)years old,of which 85 were in the Qi deficiency and blood stasis group(45.7%),44 were in the Qi and yin deficiency and blood stasis group(24.9%),and 68 were in the Yang Qi deficiency and blood stasis group(29.4%),of which the Qi deficiency and blood stasis group had the highest proportion.2.Comparing the patients’ all-cause death outcome events,19 patients in the Qi deficiency and blood stasis group died(22.9%),12 patients in the Qi and yin deficiency and blood stasis group died(25.0%),and 32 patients in the Yang Qi deficiency and blood stasis group died(44.4%).The Chinese medicine syndrome type is a risk factor for allcause death in patients with HFpEF(P<0.05).Compared with the Qi deficiency and blood stasis group and the Qi Yin deficiency and blood stasis group,the all-cause mortality rate of patients in the Yang Qi deficiency and blood stasis group was the highest(P<0.05).There were 33patients(16.3%)with central vascular death in 203 elderly HFpEF patients,with the highest proportion of Yang deficiency and blood stasis.Compared with other patients,the patients with cardiovascular death were older,the proportion of coronary heart disease was higher,and the proportion of statins was lower.NT-pro BNP,c Tn I,H-FABP,α-HBDH,lactate dehydrogenase,urea nitrogen levels were higher,and albumin levels were lower(P<0.05)3.The Chinese medicine syndrome type of HFpEF patients is used as an independent variable in the form of grouping variables,and all-cause death is a dependent variable.A single-factor Cox regression analysis of all covariates that may affect the clinical outcome is performed.The results show that the increase in sputum drinking syndrome,coronary heart disease,diabetes,cerebral infarction,NT-pro BNP,c Tn I,CK-MB,H-FABP,α-HBDH,lactate dehydrogenase,urea nitrogen,and creatinine are the risk factors for all-cause death.The use of ACEI/ARB and statins,total protein and Increased albumin levels are a protective factor in the outcome of all-cause death(P<0.05).4.The TCM syndrome type of HFpEF patients is used as an independent variable in the form of grouping variables,and all-cause death is the dependent variable.The Qi deficiency and blood stasis group is used as the reference group.Multi-factor Cox regression analysis is used to calculate the risk value of all-cause death in patients with different TCM syndrome types,and different statistical models are established to verify the stability of the results.Cox regression analysis showed that after adjusting for age,coronary heart disease,hypertension,statin application,CK-MB and α-HBDH,the risk of all-cause death in patients with HFpEF with Yangqi deficiency and blood stasis syndrome was 1.867 times higher than that of patients with Qi deficiency and blood stasis syndrome(P<0.05).Coronary heart disease,hypertension,CK-MB and α-HBDH increased as risk factors for death in patients with HFpEF,and statin use was a protective factor(P<0.05).5.After model 1 corrected the age,the risk of all-cause death of patients in the Yang Qi deficiency and blood stasis group was 2.024 times that of the qi deficiency and blood stasis group.Model 2 corrects hypertension and coronary heart disease on the basis of model 1.The risk of all-cause death in the Yang Qi deficiency and blood stasis group is2.168 times that of the Qi deficiency and blood stasis group.Model 3corrects the use of CK-MB and statins on the basis of model 2.Compared with the Qi deficiency and blood stasis group,the risk of all-cause death in the Yang Qi deficiency and blood stasis group increased by 1.741 times.Verified by different models,Qi deficiency and blood stasis syndrome and Yang Qi deficiency and blood stasis syndrome are risk factors for death outcome events in patients with HFpEF(P<0.05).Conclusion: 1.Patients with HFpEF are combined with coronary heart disease and hypertension,which are more common.2.Compared with the Qi deficiency and blood stasis group and the Qi Yin deficiency and blood stasis group,the albumin levels of elderly HFpEF patients in the Yang Qi deficiency and blood stasis group were lower,and the levels of NT-pro BNP,lactate dehydrogenase,and urea nitrogen were higher.3.The traditional Chinese medicine syndrome types of elderly HFpEF patients are mainly Qi deficiency and blood stasis syndrome.Patients with Yang Qi deficiency and blood stasis syndrome have the worst prognosis,and the all-cause mortality and cardiovascular mortality rates are the highest.After Cox regression analysis and verification of different regression models,Yang Qi deficiency and blood stasis syndrome can be used as a predictor of adverse prognosis.4.The increase in coronary heart disease,hypertension,CK-MB andα-HBDH levels can be used as risk assessment indicators,which are of certain significance for the judgment of the prognosis of elderly HFpEF patients.