| Objective:This study is to explore the epidemiological characteristics of relatedmortality in chronic heart failure and effect of Shenfu Yixin granule Decoction on theprognosis of chronic heart failure,in order to provide the research basis ofepidemiology and evidence-based medicine for improvement in the prognosis and theprevention and treatment of chronic heart failure.Methods:1.Follow up the cases of300patients with CHF already enrolled in earlystudy for four years,from October,2009to December,2013by the clinicalquestionnaire.Study on overall mortality, causes of death, and differences in mortalityabout gender,age,etiology,heart function,complications,foundation treatment anddifferences in mortality between the treatment group and the control group.2.According to put and statistics the data by the spssl9.0statistical analysis software,wewill analysis the relationship between the each index of clinical characteristics and therisk of death of heart failure and the survival difference survival between the twogroups.Results:1.The results of clinical investigation and analysis to all of the objects wasthat annual mortality rate of patients with CHF for1-4years respectively was10.2%,8.9%,9.0%,4.4%and cumulative mortality respectively of that was10.2%,18.2%,25.5%,28.8%.The short follow-up time caused no median survivaltime.2.CHF death causes were acute heart failure(71.43%),sudden cardiacdeath(8.33%),arrhythmia(7.14%), acute myocardial infarction(4.76%), multiple organfailure(3.57%),cancer(3.57%), accidental death(1.19%) in turn.The acute heart failure,sudden cardiac death,arrhythmia were accounted for the major.3.Comparing the meanof two groups of male and female1-4year cumulative mortality and survival time,sexdifference death group and survival time was not obvious, but two groups exist certain survival curve trend, the mortality of female was higher than of male.4.The death ageof CHF patients was from50to60years old that is85.7%of the total deathspopulation,that majority is60-80years old.Male died patients was65,that of femalewas19. Two groups of age at death were not consistent with thenormaldistribution(s<0).There was no significant difference between male and femalepatients with the age of death by nonparametric Wilcoxon test.The average age ofdeath M(P25,P75) was64years in total and male and female patients.5.There was nosignificant difference between the cause of coronary heart disease and dilatedcardiomyopathy. The death probability of heart failure patients with coronary heartdisease was lower than that of dilated cardiomyopathy.The cumulative survival rate ofcoronary heart disease for one to four years(90%,80%,75%,71%) were higher thanthat of dilated cardiomyopathy (90%,81%,73%,68%),the average survival time ofcoronary heart disease was longer than that of cardiomyopathy.The mortality ofcardiomyopathy was in the higher tend than coronary heart disease.6.The prognosiswas closely related with the cardiac function of the patients.The survival rate ofpatients with CHF in heart function third level was lower than than heart functionsecond level with significant statistical difference(P<0.05).7.The survival rate ofchronic heart failure patients with complications was lower than that of patientswithout complications,compared with a significant difference(P<0.05). Hypertension,diabetes,cerebrovascular disease,pulmonary diseases as chronic obstructivepulmonary disease were all common complications of CHF, its effect on the risk ofdeath was statistically significant (P<0.05).The risk of lung diseases,hypertension,cerebrovascular disease,diabetes mellitus was from high to low.8.CHFbasic therapies were still mainly beta blockers,ACEI/ARB, spironolactone,digoxin,diuretics during four years.Compared with the baseline medication,proportion of beta blockers, ACEI/ARB,spironolactone, diuretic has increased,whenthe proportion of beta blockers increased from75.6%to82.4%, of ACEI/ARBincreased from72.5%to79.3%, of spironolactone increased from68.9%to76.2%, ofdiuretics increased from52.8%to67.4%, of digoxin therapy decreased from56%to47.2%.In addition, proportion of nitrates, Qumeitaqin, calcium ion antagonist haddeclined.9.The related factors were included in the univariate Cox proportional hazardmodel for statistical analysis,the result was found that comparison between theage,primary disease,cardiac function,number of comorbidities,drug treatment inpatients with heart failure and the risk of death was statistically significant (P<0.05).Its meaning was that risk of patients with heart failure died60years of ageor older was1.643times that of <60years old in the other factors fixed, the risk ofdeath of DCM was1.580times the risk of death in coronary heart disease,heartfunction grade was1.760times the level II,every increase an increased risk ofcomplications and the death1.694times.the risk of death by increasing a complicationwould increased1.694times,standard drug therapy may reduce the risk of death inpatients with heart failure,gender,smoking,alcohol consumption on the risk of deathwas not statistically significant (P>0.05).10.There was no significant difference insurvival rate between the treatment group and the control group.The cumulativesurvival rate in treatment group for1-4years (91%,84%,76%,71%) was higherrespectively than that of the control group (89%,80%,73%,68%).The averagesurvival time of the treatment group (42.54months) was longer than that of thecontrol group(41.04months). The cumulative survival rate in treatment group was inhigher trend.Conclusion:The mortality of patients with CHF has decreased in recent years.Theacute heart failure, sudden cardiac death,arrhythmia are the main causes ofdeath,death age is60-80years of age in major.The mortality trend of female with CHFis higher than that of the male,as well as that of dilated cardiomyopathy patients withCHF is higher than coronary heart disease.The main drugs for CHF are betablockers,ACEI/ARB,digoxin,diuretic spironolactone.The age, primary disease,cardiacfunction,number of comorbidities,drug treatment are closely related to prognosis ofpatients with CHF.Shenfu Yixin granule could improve the survival rate and diseaseprognosis of chronic heart failure.We should play the advantages of Chinese medicinetreatment in CHF,pay more attention to the standardized treatment,strengthenfollow-up study in order to improve the long-term prognosis of CHF effectively basedon various factors of prognosis. |
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