Analysis Of Factors Affecting Prognosis And Quality Of Life In Patients With Stage C And D Heart Failure

Objective To observe the factors affecting prognosis and quality of life of patients with stage C and D heart failure.Methods 100 inpatients with stage C and D heart failure were selected in the second ward of department of cardiology and the fifth ward of geriatric disease in our hospital from August 2016 to April 2018;Collect patient gender,age,clinical diagnosis,LVEF,serum creatinine,NT-pro BNP,etc;EQ-5D,KCCQ-12,and PQH-8 questionnaires were used to assess the quality of life of patients;Follow-up for 1 month,6 months and 12 months and guidance of life and medication were given to the patients.Endpoint events were collected(including all-cause death,re-hospitalization for heart failure,new stroke,revascularization,myocardial infarction);The clinical risk factors and quality of life were analyzed in the endpoint and non-endpoint events,in the death group and the survival group;Quality of life in the survival group was compared between optimal medical therapy and no-optimal medical therapy of heart failure.Results 1.During the follow-up,56 patients had terminal events and 28 died;2.Comparison of clinical data between the endpoint event group and the no endpoint event group heart function NYHA class III and IV grade proportion respectively [24(42.9%),32(57.1%),34(72.7%),11(25.0%),P = 0.002),merger pleural effusion proportion respectively [36(65.5%),17(38.6%),P = 0.008),creatinine clearance,respectively(60.04 ±25.44,71.18 ±26.48,P = 0.035),the NT-pro BNP value respectively [4370(2112113 75),3030.5(1105.03,4770.25),P = 0.005];3.Comparison of quality of life between the endpoint event group and the non-endpoint event group existing depression scale,respectively [41(73.2%),17(38.6%),P = 0.001];4.Capacity analysis predict the end events ROC analysis found that the NT-pro BNP,NYHA heart function classification can predict the end events occur,the area under the curve and P values respectively(0.665,0.666,0.005,0.005);5.Death and survival group clinical data comparison LVEF respectively(43.64±13.64,51.167 ± 13.68,P = 0.015),merger pleural effusion proportion respectively [20(71.43%),33(45.83%),P = 0.012),creatinine clearance respectively [51.71±24.16,70.08± 25.53,P = 0.001],NT-pro BNP value respectively [9980(23),3600163,3096(1201.75,5126),P = 0.015);6.Death and survival group compare quality of life exist depression scale respectively [26(92.9%),32(44.4%),P = 0.000),EQ-5D 、 EQ-5D-VAS 、 KCCQ-12 questionnaire scores respectively [0.23(0.01,0.55),0.60(0.26,0.83),P = 0.001],[45(23.75,57.50),60(50reached),P = 0.014],[14.79(4.99,30.63),32.40(12.34,59.95),P=0.016];7.Ability to predict death analysis ROC analysis found that the NT-pro BNP,LVEF,kidney is not universal forecasting the occurrence of death,the area under the curve and P values respectively(0.76,0.647,0.652,0.000,0.023,0.019);8.12 month follow-up survival group compared with health scale score on admission quality of life improved significantly;9.In the survival group,the idealized medication therapies of improvement the cardiac function was better than that of non-idealized medication therapies,the 12 month follow-up NT-pro BNP values respectively [468(305.25,1437.5),913.55(534.61,2525.50),P = 0.017)Conclusion 1.C,D stage of heart failure in patients with high fatality rate,longer hospitalization rates high,poor quality of survival;2.The NT-pro BNP,NYHA heart function classification can predict main adverse cardiovascular and cerebrovascular events in patients with stage C and D heart failure;3.The NT-probnp,LVEF,renal dysfunction can predicted the death of patients with stage C and D heart failure;4.The quality of life of patients with stage C and D heart failure was improved by comprehensive management of drug use and life guidance.