Risk stratification in ambulatory patients with heart failure and chronic obstructive pulmonary disease: evaluation of predictive value of standard prognostic markers for 5-years survival

The purpose of the study was to assess the predictive value of standard prognostic markers in ambulatory patients with heart failure (HF) and chronic obstructive pulmonary disease (COPD) discharged after heart failure hospitalization. We used prospectively collected information, including medical history, physical examination, 6-minute walking test, chest X-ray, electrocardiogram, echocardiography, blood test (including brain natriuretic peptide (BNP)) (totally 450 variables) in 98 hospitalized patients 45-65 years old (mean age 61 ± 0,8 years, 75 men), with NYHA class HF II-IV, COPD 2-4 stage. After hospital discharge all patients were followed up by cardiologists specialized in HF for a mean period of 5 years. Correlation analysis was used to assess the predictive value of standard prognostic markers. 5-year survival was 81 %. Prognostic markers including older age, ischemic aetiology of HF, diabetes mellitus, angiotensine converting enzyme-inhibitors and β-blockers therapy, tachycardia, low blood pressure, low body mass index, marked elevation of BNP, creatinine, bilirubin, anemia, hyponatriemia, low left ventricular ejection fraction, restrictive mitral filling pattern had no influence on 5-year survival in HF patients with COPD.

prognosis, heart failure, chronic obstructive pulmonary disease, out-patient monitoring, cardiologist specialized in heart failure

1. Kannel W.B. Epidemiology and prevention of cardiac failure: Framingam Study insights // Eur. Heart J. - 1987. - Vol. 8, № 23 (Suppl. F). - P. 6.

2.

3. Congestive Heart Failure in the United States: A new epidemic. Data Facts Sheets. Bethesda, Md. National Heart, Lung and Blood institute.

4.

5. Cowie M.R. The epidemiology of heart failure // Eur. Heart J. - 1997. - Vol. 18, № 2. - P. 208-223.

6.

7. Guidelines for diagnosis and treatment of Acute and Chronic heart failure 2008 // Eur. Heart J. - 2008. doi: 10.1093/eurheartj/ehl309.

8.

9. Curkendall S.M., deLuise C., Jones J.K., Lanes S. et al. Cardiovascular Disease in Patients with Chronic Obstructive Pulmonary Disease, Saskatchewan Canada: Cardiovascular Disease in COPD Patients //Ann. Epidemiol. - 2006. - Vol. 16, Issue 1. - P. 63-70.

10.

11. Федотов П.А. Динамика клинических проявлений сердечной недостаточности у больных с сопутствующим хроническим бронхитом в ходе стандартной терапии // Бюлл. ННИК. - 2005. - Т. 3, № 1. - С. 167-170.

12.

13. Оптимальное применение ингибиторов ангиотензин-превращающего фермента и бета-адреноблокаторов при лечении больных хронической сердечной недостаточностью. Пособие для врачей. СПб, 2005. - С. 35.

14.

15. Kjøller E., Kшber L., Iversen K., Torp-Pedersen C. on behalf of the Trace Study Group . Importance of chronic obstructive pulmonary disease for prognosis and diagnosis of congestive heart failure in patients with acute myocardial infarction. European Society of Cardiology // Eur. J. Heart Fail. - 2004. - Vol. 6, Issue 1. - P. 71-77.

16.

17. Sin D.D., Man S.F.P. Are Patients With Chronic Obstructive Pulmonary Disease at Increased Risk of Cardiovascular Morbidity and Mortality? // Cardiovasc. Rev. Rep. - 2004. - Vol. 25, № 4. - P. 168-170.

18.

19. Ситникова М.Ю., Лелявина Т.А., Дорофейков В.В. Способ прогнозирования выживаемости пациентов старческого возраста с хронической сердечной недостаточностью. Приоритетная справка Роспатента от 09.07.2007, рег. №2007126115.2.

20.

21. Shlyakhto E., Sitnikova M., Lelyavina T. The Age-BNP Survival Model: Prediction of survival in old (>75 years) patients with heart failure // Circulation. - 2008. -Vol. 117, № 19. - P. 486.

22.

23. Sitnikova M., Ivanov S., Krasnova O., Shlyakhto E. Interaction between the ACE polymorphism genes (insertion/deletion) and the particular clinical features of congestive heart failure, structural and functional indexes of the heart and mortality. // Circulation. - 2008. - Vol. 117, № 19. - P. 487.

24.

25. Sitnikova М.Yu., Lelyavina Т.А., Slyakhto Е.W. et al. Diagnosis and prognosis of hospitalized elderly heart failure patients // J. Heart Fail. - 2006. - Vol. 7, № 2. - P. 85-87.

26.

27. Ситникова М.Ю., Лелявина Т.А., Шляхто Е.В. и др. Эффективность и прогностическая ценность методов диагностики тяжести хронической сердечной недостаточности у пациентов разного возраста // Артериальная гипертензия. - 2008. - Т. 14, № 1. - С. 5-11.

28.

29. Rumsfeld J.M. Heart failure disease management works, but will it succeed? // Eur. Heart J. - 2004. - Vol. 25, № 18. - P. 1565-1567.

30.

31. Gonseth J. The effectiveness of disease management programmes in reducing hospital readmission in older patient with heart failure: a systematic review and meta-analysis of published reports // Eur. Heart J. - 2004. - Vol. 25, № 18. - P. 1570-1595.

32.

33. Cline C.M. A cost effective management programme for heart failure reduced hospitalization // Heart. - 1998. - Vol. 80, № 9. - P. 442-446.

34.

35. Gustafsson F. Heart failure clinics and outpatient management: review of evidence and call for quality assurance // Eur. Heart J. - 2004. - Vol. 25, № 18. - P. 1596-1604.

36.

37. Агеев Ф.Т., Мареев В.Ю., Середенина Е.М. Перспективы внедрения специализированных форм активного амбулаторного ведения больных с сердечной недостаточностью: структура, методика и предварительные результаты российской программы «Шанс».

38.

39. Мареев В.Ю., Агеев Ф.Т., Арутюнов Г.П. и др. Национальные рекомендации по диагностике и лечению ХСН (второй пересмотр) // Журн. Сердечная Недостаточность. - 2007. - Т. 8, № 2. - С. 1-35.

40.

41. Cody R.J. Clinical trials of diuretic therapy in heart failure: research direction and clinical considerations // J. Am. Coll. Cardiol. - 1993. - Vol. 22. - P. 165A-171A.

42.

43. Guidelines for the diagnosis and treatment of Chronic Heart Failure: full text (update 2005). European Society Of Cardiology.

44.

45. Standards for the diagnosis and treatment of patients with COPD // Eur. Respir. J. - 2004. - Vol. 23. - P. 932-946.

46.

47. Standards for the diagnosis and treatment of patients with COPD // Eur. Respir. J. 2006.

48.

49. Воронков Л.Г., Яновский Г.В., Устименко Е.В. и др. Предикторы 5-летней выживаемости больной и индивидуальное прогнозирование течения клинически манифестированной сердечной недостаточности // Украинская медицина. - 2003. - Vol. 38, № 6. - С. 106-109.

50.

51. Remme W.J., McMurray J.J.V., Hobbs F.D.R. et al. Awareness and perception of heart failure among European cardiologists, internists, geriatricians and primary care physicians // Eur. Heart J. - 2008. doi:10.1093/eurheartj/ehn196.

52.

53. Mahjoub H., Rusinaru D., Souliere V. et al. Long-term survival in patients elderly than 80 years hospitalized for heart failure. A 5-year prospective study // Eur. J. Heart Fail. - 2008. - Vol. 10. - P. 78-84.

54.