Patients after acute decompensation of Heart Failure: adherence to self-monitoring and treatment depending on the mode of outpatient monitoring

Aim      To evaluate compliance with self-monitoring and drug and non-drug treatment of patients after ADHF during the management at a specialized center for CHF treatment (CCHF) or in real-life clinical practice.

Material and methods  The study included 942 CHF patients after ADHF. In two years, the entire sample of patients was retrospectively divided into 4 groups based on their compliance with the management at the CCHF: group 1, 313 patients who were managed at the CCHF continuously for two years; group 2, 383 patients who choose the management at district outpatient clinics after discharge from a hospital; group 3, 197 patients who visited the CCHF for one year but then stopped the management; and group 4, 49 patients who initially preferred the management at district clinics but then switched to constant management at the CCHF. Compliance with recommendations was analyzed by data of outpatient clinical records or by data of structured telephone calls for patients who did not visit the CCHF or did not follow the visit schedule. Statistics was performed with a Statistica 7.0 for Windows software package.

Results Patients of groups 2 (72.4 %) and 3 (88.3 %) performed self-monitoring less frequently whereas patients of groups 1 (94.6 %) and 4 (87.8 %) performed self-monitoring more frequently (р_1 / 3=0.01, р_1 / 2<0.001, р_1 / 4=0.07, р_2 / 4=0.02, р_2 / 3<0.001, р_4 / 3=0.9). Patients of group 2 (58.1 %) performed self-monitoring of heart rate less frequently than patients of groups 1, 3, and 4 (90.7 %, 81.7 %, and 87.8 %; р_1 / 3=0.003, р_1 / 2<0.001, р_1 / 4=0.5, р_2 / 4<0.001, р_2 / 3<0.001, and р_4 / 3=0.3). Patients of group 2 performed body weight self-monitoring less frequently than patients of groups 1, 3, and 4 (78.6 %, 67.9 %, and 72.9 %; р_1 / 3=0.008, р_1 / 2<0.001, р_1 / 4=0.4, р_2 / 4=0.002, р_2 / 3<0.001, and р_4 / 3=0.5). Compliance with the diet and restriction of salt consumption was 32.3 % and 37.5 % in groups 1 and 4, and 24.9 % and 19.9 % in groups 2 and 3 (р_1 / 3=0.002, р_1 / 2=0.03, р_1 / 4=0.5, р_2 / 4=0.02, р_2 / 3=0.2, and р_4 / 3=0.009). Compliance with recommendations on physical rehabilitation was 44.7% in group 1, which was better than in groups 2, 3, and 4 (8.2 %, 21.6 %, and 9.1 %; р_1 / 2<0.001, р_1 / 3=0.0003, р_1 / 4=0.002, р_2 / 4=0.9, р_2 / 3=0.0006, and р_4 / 3=0.2). At the end of the second year of follow-up, the actual proportion of patients taking ACE inhibitors/angiotensin receptor antagonists was low in groups 2, 3, and 4 (43.2 %, 45 %, and 66.7 %) and satisfactory in group 1 (92.4 %; р_1 / 2<0.001, р_1 / 3<0.001, р_1 / 4<0.001, р_2 / 3=0.6, р_2 / 4=0.05, and р_3 / 4=0.05). Proportion of patients taking beta-blockers was greater in group 1 (97.2 %) than in groups 2, 3. and 4 (73.2 %, 71.1 %, and 90.5 %; р_1 / 2<0.001, р_1 / 3<0.001, р_1 / 4=00.08, р_2 / 3=0.6, р_2 / 4=0.1, and р_3 / 4=0.06). Patients of group 1 (96.2 %) showed good compliance with the mineralocorticoid receptor antagonist treatment compared to groups 2, 3, and 4 (58.8 %, 55.4 %, and 81.2 %; р_1 / 2<0.001, р_1 / 3<0.001, р_1 / 4<0.001, р_2 / 3=0.5, р_2 / 4=0.1, and р_3 / 4=0.

Conclusion      Only scheduled management by a cardiologist of the specialized CCHF provided sufficient compliance with self-monitoring and drug and non-drug treatment of CHF during the long-term follow-up.

1. Maggioni AP, Dahlström U, Filippatos G, Chioncel O, Crespo Leiro M, Drozdz J et al. EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). European Journal of Heart Failure. 2013;15(7):808–17. DOI: 10.1093/eurjhf/hft050

2. Polyakov D.S., Fomin I.V., Valikulova F.Yu., Vaisberg A.R., Kraiem N., Badin Yu.V. et al. The EPOCHA-CHF epidemiological program: decompensated chronic heart failure in real-life clinical practice (EPOCHA-D-CHF). Russian Heart Failure Journal. 2016;17(5):299– 305. DOI: 10.18087/rhfj.2016.5.2239

3. Kapoor JR, Kapoor R, Ju C, Heidenreich PA, Eapen ZJ, Hernandez AF et al. Precipitating Clinical Factors, Heart Failure Characterization, and Outcomes in Patients Hospitalized with Heart Failure With Reduced, Borderline, and Preserved Ejection Fraction. JACC: Heart Failure. 2016;4(6):464–72. DOI: 10.1016/j.jchf.2016.02.017

4. Arutyunov A.G., Dragunov D.O., Arutyunov G.P., Sokolova A.V. Impact of the dosing of basic drugs on the risk of rehospitalization in patients with chronic heart failure. Therapeutic Archive. 2016;88(1):29– 34. DOI: 10.17116/terarkh201688129-34

5. De Peuter OR, Lip GYH, Souverein PC, Klungel OH, de Boer A, Büller HR et al. Time-trends in treatment and cardiovascular events in patients with heart failure: a pharmacosurveillance study. European Journal of Heart Failure. 2011;13(5):489–95. DOI: 10.1093/eurjhf/hfq228

6. Gislason GH, Rasmussen JN, Abildstrom SZ, Schramm TK, Hansen ML, Buch P et al. Persistent Use of Evidence-Based Pharmacotherapy in Heart Failure Is Associated with Improved Outcomes. Circulation. 2007;116(7):737–44. DOI: 10.1161/CIRCULATIONAHA.106.669101

7. Belenkov Yu.N., Mareev V.Yu., Ageev F.T., Fomin I.V., Badin Yu.V., Polyakov D.S. et al. Veritable prevalence of CHF in the European part of Russian Federation (EPOCHA trial, hospital stage). Russian Heart Failure Journal. 2011;12(2):63–8.

8. Belenkov Yu.N., Mareev V.Yu., Ageev F.T., Fomin I.V., Badin Yu.V., Polyakov D.S. et al. Modern character of CHF patients in the European part of the Russian Federation (hospital stage). Russian Heart Failure Journal. 2011;12(5):255–9.

9. Fomin I.V. Chronic heart failure in Russian Federation: what do we know and what to do. Russian Journal of Cardiology. 2016;8:7–13. DOI: 10.15829/15604071-2016-8-7-13

10. Scherbinina E.V., Mareev V.Yu., Fomin I.V., Shustova T.S. The use of beta-blockers in patients with heart failure in the Nizhny Novgorod region. Actual practice data (1998-2000). Russian Heart Failure Journal. 2001;2(2):52–3.

11. Fomin I.V., Mareev V.Yu., Zherbinina E.V. Indicators of the prevalence of heart failure and the effectiveness of its therapy, depending on the severity of the disease. Russian Heart Failure Journal. 2002;3(2):69–70.

12. Fomin I.V., Polyakov D.S. Beta-blockers, and real clinical practice in Russia: the gap between the understanding of the doses of beta-blockers and subsequent prognosis in patients with cardiovascular disease. Systemic Hypertension. 2017;14(3):36–41.

13. Shah KS, Xu H, Matsouaka RA, Bhatt DL, Heidenreich PA, Hernandez AF et al. Heart Failure With Preserved, Borderline, and Reduced Ejection Fraction. Journal of the American College of Cardiology. 2017;70(20):2476–86. DOI: 10.1016/j.jacc.2017.08.074

14. Maggioni AP, Anker SD, Dahlström U, Filippatos G, Ponikowski P, Zannad F et al. Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long-Term Registry. European Journal of Heart Failure. 2013;15(10):1173–84. DOI: 10.1093/eurjhf/hft134

15. Komajda M, Anker SD, Cowie MR, Filippatos GS, Mengelle B, Ponikowski P et al. Physicians’ adherence to guideline-recommended medications in heart failure with reduced ejection fraction: data from the QUALIFY global survey: Adherence to heart failure guidelines. European Journal of Heart Failure. 2016;18(5):514–22. DOI: 10.1002/ejhf.510

16. Mureddu GF, Agabiti N, Rizzello V, Forastiere F, Latini R, Cesaroni G et al. Prevalence of preclinical and clinical heart failure in the elderly. A population-based study in Central Italy. European Journal of Heart Failure. 2012;14(7):718–29. DOI: 10.1093/eurjhf/hfs052

17. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal. 2016;37(27):2129–200. DOI: 10.1093/eurheartj/ehw128

18. Mareev V.Yu., Fomin I.V., Ageev F.T., Begrambekova Yu.L., Vasyuk Yu.A., Garganeeva A.A. et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(6S):8–164. DOI: 10.18087/cardio.2475

19. Polyakov D.S., Fomin I.V., Shkarin V.V., Gurvich E.V., Kraiem N. EPOCHA-D-CHF: gender differences in prognosis for acute decompensated heart failoure in real clinical practice (part 1). Women’s health problems. 2017;12(2):11–21.

20. Wolfel EE. Can we predict and prevent the onset of acute decompensated heart failure? Circulation. 2007;116(14):1526–9. DOI: 10.1161/CIRCULATIONAHA.107.729608

21. Solomon SD, Dobson J, Pocock S, Skali H, McMurray JJV, Granger CB et al. Influence of Nonfatal Hospitalization for Heart Failure on Subsequent Mortality in Patients With Chronic Heart Failure. Circulation. 2007;116(13):1482–7. DOI: 10.1161/CIRCULATIONAHA.107.696906

22. Setoguchi S, Stevenson LW, Schneeweiss S. Repeated hospitalizations predict mortality in the community population with heart failure. American Heart Journal. 2007;154(2):260–6. DOI: 10.1016/j.ahj.2007.01.041

23. Van der Wal MHL, van Veldhuisen DJ, Veeger NJGM, Rutten FH, Jaarsma T. Compliance with non-pharmacological recommendations and outcome in heart failure patients. European Heart Journal. 2010;31(12):1486–93. DOI: 10.1093/eurheartj/ehq091

24. Van der Wal MHL, Jaarsma T, Moser DK, van Gilst WH, van Veldhuisen DJ. Qualitative examination of compliance in heart failure patients in The Netherlands. Heart & Lung. 2010;39(2):121–30. DOI: 10.1016/j.hrtlng.2009.07.008

25. Mareev V.Yu., Begrambekova Yu.L., Danielyan M.O., Ageev F.T., Gilyarevskiy S.R., Belenkov Yu.N. et al. What questions are asked and answered by studies of non-drug treatment in patients with heart failure. Lessons from the CHANCE study. Russian Heart Failure Journal. 2014;15(6):383–96.

26. Lainscak M, Blue L, Clark AL, Dahlström U, Dickstein K, Ekman I et al. Self-care management of heart failure: practical recommendations from the Patient Care Committee of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure. 2011;13(2):115–26. DOI: 10.1093/eurjhf/hfq219

27. La Rovere MT, Traversi E. Role and efficacy of cardiac rehabilitation in patients with heart failure. Monaldi Archives for Chest Disease. 2019;89(1). DOI: 10.4081/monaldi.2019.1027

28. von Scheidt W, Zugck C, Pauschinger M, Hambrecht R, Bruder O, Hartmann A et al. Characteristics, management modalities and outcome in chronic systolic heart failure patients treated in tertiary care centers: results from the EVIdence based TreAtment in Heart Failure (EVITAHF) registry. Clinical Research in Cardiology. 2014;103(12):1006–14. DOI: 10.1007/s00392-014-0743-x

29. McAlister FA, Stewart S, Ferrua S, McMurray JJJV. Multidisciplinary strategies for the management of heart failure patients at high risk for admission. Journal of the American College of Cardiology. 2004;44(4):810–9. DOI: 10.1016/j.jacc.2004.05.055

30. Sochalski J, Jaarsma T, Krumholz HM, Laramee A, McMurray JJV, Naylor MD et al. What Works In Chronic Care Management: The Case of Heart Failure. Health Affairs. 2009;28(1):179–89. DOI: 10.1377/hlthaff.28.1.179

31. Formiga F, Chivite D, Manito N, Casas S, Llopis F, Pujol R. Hospitalization due to acute heart failure. Role of the precipitating factors. International Journal of Cardiology. 2007;120(2):237–41. DOI: 10.1016/j.ijcard.2006.10.004

32. Evangelista LS, Berg J, Dracup K. Relationship between psychosocial variables and compliance in patients with heart failure. Heart & Lung. 2001;30(4):294–301. DOI: 10.1067/mhl.2001.116011

33. Strömberg A, Mårtensson J, Fridlund B, Levin L-A, Karlsson J-E, Dahlström U. Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: results from a prospective, randomised trial. European Heart Journal. 2003;24(11):1014–23. DOI: 10.1016/S0195-668X(03)00112-X

34. Artinian NT, Magnan M, Sloan M, Lange MP. Self-care behaviors among patients with heart failure. Heart & Lung. 2002;31(3):161–72. DOI: 10.1067/mhl.2002.12367

35. 2 35. O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ et al. Efficacy and Safety of Exercise Training in Patients with Chronic Heart Failure: HF-ACTION Randomized Controlled Trial. JAMA. 2009;301(14):1439–50. DOI: 10.1001/jama.2009.454

36. Tierney S, Mamas M, Woods S, Rutter MK, Gibson M, Neyses L et al. What strategies are effective for exercise adherence in heart failure? A systematic review of controlled studies. Heart Failure Reviews. 2012;17(1):107–15. DOI: 10.1007/s10741-011-9252-4

37. van der Wal MHL, Jaarsma T, Moser DK, Veeger NJGM, van Gilst WH, van Veldhuisen DJ. Compliance in heart failure patients: the importance of knowledge and beliefs. European Heart Journal. 2006;27(4):434–40. DOI: 10.1093/eurheartj/ehi603

38. Begrambekova Yu.L., Mareev V.Yu. Will a patient with heart failure become an “expert patient”? Russian Heart Failure Journal. 2014;15(2):110–20.