Study On The Correlation Between Volume Management And Infarction/embolism In The Acute Phase Of Heart Failure And Observation Of The Efficacy Of Yiqi Tongluo Prescriptio

BackgroundHeart failure is a disease with high mortality.Severe infarction/embolism events such as acute myocardial infarction,cerebral infarction,and pulmonary embolism are important causes of death in patients with heart failure.The first diagnosis of heart failure and acute exacerbation of heart failure are associated with higher risk of infarction/embolism events.Prophylactic anti-thrombotic therapy has not yet achieved satisfactory results in current clinical studies,and it is necessary to further clarify the risk factors that increase the risk.Volume management during the acute phase of heart failure can affect the distribution of fluid and plasma osmotic pressure in patients and activate the neurohumoral system,but its correlation with secondary infarction/embolism events in patients with heart failure is not clear,and further correlation studies are needed.Meanwhile,traditional Chinese medicine has always attached great importance to the treatment of water and blood stasis in heart failure,and it is necessary to evaluate the effectiveness of Chinese medicine in treating patients with acute heart failure and its impact on volume management in heart failure.PurposeTo explore the correlation between volume management and infarction/embolism events,and to evaluate the efficacy of Yiqi Tongluo Formula on the prognosis of heart failure patients and its impact on volume management during hospitalization.MethodsThis study was divided into two parts,both of which used a retrospective study design.In the first part,all heart failure patients without acute myocardial infarction or pulmonary embolism before admission were included from the database of Xiyuan Hospital.Daily net fluid balance was used to represent the patients’ volume management during hospitalization.Logistic regression was used to analyze the factors associated with the occurrence of severe myocardial infarction or pulmonary embolism during hospitalization,evaluating the correlation between volume management and these events,and analyzing other risk factors.In the second part,critically ill heart failure patients who received Yiqi Tongluo Formula and those who did not receive traditional Chinese medicine decoction were included from the database and compared using Cox regression analysis to evaluate the effect of Yiqi Tongluo Formula on in-hospital survival.Linear regression was used to evaluate the correlation between the use of Yiqi Tongluo Formula and the patient’s volume management during hospitalization.ResultsThe first part of the study included 2333 patients with acute or exacerbated chronic heart failure,among whom 167(7.2%)developed acute myocardial infarction,acute stroke,or acute pulmonary embolism.The main findings of this part showed that an increase in daily net fluid output in acute heart failure patients was a protective factor against severe infarction/embolism events during hospitalization.Using 500ml/day as a stratification standard,logistic analysis was performed by dividing the daily net fluid output into 7 layers ranging from-1500ml/day to above 1500ml/day,and the odds ratio(OR)was 0.856(95%confidence interval(CI):0.735-0.997).In contrast,elevated admission platelet count,N-terminal pro-brain natriuretic peptide,D-dimer levels,and a history of hypertension were all risk factors for severe infarction/embolism events in patients,with ORs of 1.205(95%CI:1.045-1.391),1.468(95%CI:1.255-1.718),1.383(95%CI:1.183-1.618),and 1.582(95%CI:1.063-2.355),respectively.The second part included 407 critically ill heart failure patients admitted to the emergency department or ICU,of whom 81 received treatment withYiqi Tongluo Formula during hospitalization.Multivariate Cox regression analysis showed that the use ofYiqi Tongluo Formula(HR=0.294,P=0.000),combined shock(HR=2.098,P=0.005),use of vasodilators(HR=13.951,P=0.000),use of respiratory support(HR=3.337,P=0.000),and severity of heart failure were significantly associated with in-hospital mortality.Finally,237 cases with complete intake/output data were included,and linear regression analysis was performed on the daily net fluid output.In the final multivariate regression model,Yiqi Tongluo Formula was positively associated with daily net fluid output,and the correlation was statistically significant(β=0.130,P=0.021).Conclusion:1.For hospitalized patients with acute heart failure or acute exacerbation of chronic heart failure,increasing daily net output can reduce the overall risk of acute myocardial infarction,acute pulmonary embolism,and acute cerebral infarction during hospitalization.2.Elevated levels of N-terminal pro-brain natriuretic peptide,D-dimer,platelets and a history of hypertension on admission are associated with a higher risk of severe myocardial infarction/embolism during hospitalization in patients with acute heart failure or acute exacerbation of chronic heart failure.3.Compared with severe heart failure patients who did not use traditional Chinese medicine formula,the risk of in-hospital mortality was reduced in patients who used Yiqi Tongluo Formula.4.The use of Yiqi Tongluo Formula is positively correlated with an increase in daily net output during hospitalization in severe heart failure patients.