Analysis Of Prognostic Factors Of Chronic Heart Failure And Intervention Of Traditional Chinese Medicine

Objective:For patients with Chronic Heart Failure (CHF), evaluate the relevance between rehospitalization rate and related factors, the major is about the condition of Traditional Chinese Medicine (TCM) interventional treatment outside the hospital.Methods:It is a retrospective study. Selected the hospitalized patients with CHF as the research object, from January 2009 to January 2013, take the first medical record. For this research, collecte the general information and clinical data, record the TCM syndromes with it’s property and elements. Besides, follow through calls and return visit, to reach the outcome or to one year, the projects include the situation of rehospitalization and survival, the condition of TCM used outside the hospital, and so on. The retrospective study, describe the prence data of CHF and the rehospitalization rate within six mouths or one year, then use the method of single factor analysis and Logistic regression analysis, to evaluate the relevance between rehospitalization rate and the condition of TCM interventional treatment outside the hospital or other factors.Results:197 cases of CHF patents are included in this study eventually.93 cases(47.2%) of male,104 cases(52.8%) of female. Mean age 76.07±9.55 years old,75-84 years old patients account for 53.3%. NYHA classIV in 67 cases (34%), NYHA classIII in 113 cases (57.4%), NYHA classⅡ in 17 cases(8.6%). The cause of CHF, Coronary Heart Disease in 77.7%, Hypertensive Cardiopathy in 8.6%, Dilated Cardiomyopathy in 5.1%, Rheumatic Heart Disease in 4.1%. The combined disease, Hypertension in 70.6% of the most common, followed by pulmonary infection 43.1%, Rrhythmia in 40.6%, Diabetic 29.9%, Old Myocardial Infarction in 24.9%. Smoking is 8.6%, drinking is 9.6%. The outcome of significantly improved in 65.5%, improved in 34.5%. The proportion of people who taking TCM continuously out of the hospital is 16.2%, the proportion of people who taking the TCM interruptedly is 68.5%, the proportion of people who never taking TCM is 15.2%. Patients with good Western Medicine adherence outside the hospital is 59.4%, with poor Western Medicine adherence is 40.6%. Regular follow-up visit per month accounted for 82.7%, the proportion of irregular is 17.3%. Syndrome of intermingled deficiency and excess in 183 cases of the most common TCM disease syndrome element. The most common six kinds of element combination are Qi deficiency+blood stasis (31 cases), Qi deficiency+blood stasis+Yang deficiency+water stop(21 cases), Qi deficiency+blood stasis+water stop(18 cases), Qi deficiency+Yang deficiency+blood stasis(16 cases), Qi deficiency+blood stasis+sputum(14 cases), Qi deficiency+Yin deficiency+blood stasis+sputum(13 cases). According to the frequency of the elements are blood stasis (89.3%), Qi deficiency(78.7%), Yang deficiency(44.2%), water stop(39.1%) sputum(25.4%), Yin deficiency(19.8%), fluid(6.6%). Qi deficiency is the most frequently seen of deficiency syndrome element, followed by Yang deficiency. Blood stasisis the most frequently seen of excess syndrome element, followed by water stop. Within six mouths, the rehospitalization rate due to heart failure is 25.9%, all-cause mortality rate is 5.6%. Within one year, the rehospitalization rate due to heart failure is 46.7%, all-cause mortality rate is 12.-2%.37.5% of the patient who taking TCM continuously are rehospitalized within one year.44.4% of the patient who taking TCM interruptedly are rehospitalized within one year.66.7% of the patient who never taking TCM are rehospitalized within one year, the rehospitalization rate about three kinds of TCM interventional treatment outside the hospital are different, with statistical significance(x2=6.169, P=0.046). In addition, by single factor analysis, about the rehospitalization rate, there are also significant differences in age(x2=13.248, P=0.004), NYHA class (x2=7.775, P=0.020), clinical outcome (x2=4.734, P=0.036), Western Medicine compliance outside the hospital (x2=4.935, P=0.030), and follow-up visit condition(x2=5.352, P=0.024) Logistic regression analysis show that, as the continuity of TCM interventional treatment outside the hospital by continuous taking-intermittent taking-not taking,2.291 times increase in rehospitalization risk within one year(x2=6.518 P=0.011,0R=2.291). In addition, age(x2=9.485, P=0.002,OR=1.063), NYHA class(x 2=5.783, P=0.016,OR=0.506), clinical outcome(x2=3.874, P=0.049, OR=1.918), also affect rehospitalization rate obviously.Conclusion:In this retrospective study, the rehospitalization rate and mortality rate within six mouths or one year is improved, but the hospitalization rate is still at a high level.The higher the continuity of TCM interventional treatment outside the hospital, the rehospitalization rate within one year is lower. TCM interventional treatment outside the hospital, and age, NYHA class and clinical outcome, are dependent of influential factors of the rehospitalization rate within one year. The most common TCM syndrome is intermingled deficiency and excess, blood stasis and Qi deficiency is the most common elements, followed by Yang deficiency and water stop. The therapy is mainly by tonifying Qi and promoting blood flow, with warming Yang and alleviating water retention. In TCM dialectical, the four ways of diagnosis about inspection, auscultation and olfaction, inquiry, pulse-taking and palpation is very important. Patients with CHF admitted in TCM hospital, most of them choose the conbined interventional treatment of TCM and western medicine outside the hospital, but the continuity of TCM taking needs to improve.