Results of 3 years work of the Russian hospital register of chronic heart failure (RUssian hoSpital Heart Failure Registry -RUS-HFR): relationship between management and outcomes in patients with chronic heart failure

Aim. To analyze management and outcomes in patients with CHF managed by specialists in heart failure (HF) or general cardiologists/ physicians in real-life clinical practice. Materials and methods. Survival rate, rehospitalization rate, general health condition, and the administered therapy were evaluated for HF patients with reduced LV ejection fraction at three years of discharge from cardiological hospitals. These patients had been included in a prospective, multicenter, observational study, “The Russian Hospital HF Registry” (RUS-HFR). The first group consisted of patients who were managed at a specialized HF department of the Federal Center and followed up at the outpatient stage by a cardiologist specializing in HF (Group 1, St.-Petersburg; n =74). The other two groups (Group 2 and Group 3) included patients who were managed at other cardiological departments of the Federal Center (n=186) or the Regional Center (n=130) and subsequently followed up at the place of residence. Results. After the discharge from the hospital, 58-95 and 12-19% of RUS-HFR patients were followed up by a cardiologist or a physician, respectively, on an outpatient basis while 5-23% of patients did not visit a doctor at all. In three years, the survival rate of Group 1, 2, and 3 patients was 80 vs. 78 (р>0.05) vs. 52% (р<0.01) (these differences were most obvious for patients with functional class III CHF), and the rate of hospitalization for decompensated HF was 33 vs. 28 (р>0.05) vs. 100% (p_1,2<0.01), respectively. Specialists in HF more frequently prescribed ACE inhibitors/angiotensin receptor antagonists, beta-blockers, mineralocorticoid receptor antagonists, and diuretics (89, 91, 75, and 88% of cases vs. 67-73, 81-85, 54-55, and 60-79% of cases, respectively) and more frequently than other doctors titrated ACE inhibitors/angiotensin receptor antagonists and beta-blockers to ≥50% of a target dose -46 vs. 26-38% and 74 vs. 52-56%, respectively. High-tech care was more frequently recommended and used for patients of Group 1 and Group 2. During the follow-up period, electrophysiological methods of treatment were recommended and used only for Federal Center patients. Conclusion. Despite similar recommendations on drug therapy, the mortality and rehospitalization rates may considerably differ in patients with CHF depending on the management at the outpatient stage. Multimodality cardiological centers that include specialized HF departments have comprehensive capacities for examination and treatment of HF patients with reduced LV ejection fraction providing high-tech treatments and a multidisciplinary approach. HF specialists use more aggressive tactics with respect of the quality and volume of drug therapy, which, along with successive management and correction of patients’ compliance, is associated with lower rates of mortality and rehospitalizations.

специалист по сердечной недостаточности, СНнФВ, менеджмент, регистр RUS-HFR, heart failure specialist, HFrEF, management, registry RUS-HFR

1. Ponikowski P, Voors AA, Anker SD, Bueno H, ClelandJGF, 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) ofthe ESC. EurJ Heart Fail. 2016,18 (8):891-975. DOI:10.1002/ejhf. 592

2. Roccaforte R., Demers C., Baldassarre F., K. Teo K., Yusuf S. Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A meta-analysis. EurJ Heart Fail. 2005;7 (7):1133-44. DOI:10.1016/j. ejheart. 2005.08.005

3. Comín-Colet J., Verdú-Rotellar JM, Vela E., Clèries M., Bustins M., Mendoza L. et al. Efficacy of an Integrated Hospital-primary Care Program for Heart Failure: A Population-based Analysis of 56742 Patients. Rev Esp Cardiol Engl Ed. 2014;67 (4):283-93. DOI:10.1016/j. rec. 2013.12.005

4. Álvarez-García J., Salamanca-Bautista P., Ferrero-Gregori A., Mon-tero-Pérez-Barquero M., Puig T., Aramburu-Bodas Ó et al. Prognostic Impact of Physician Specialty on the Prognosis of Outpatients With Heart Failure: Propensity Matched Analysis of the REDINSCOR and RICA Registries. Rev Esp Cardiol Engl Ed. 2017;70 (5):347-54. DOI:10.1016/j. rec. 2016.12.026

5. Jankowska EA, Kalicinska E., Drozd M., Kurian B., Banasiak W., Ponikowski P. Comparison of clinical profile and management of outpatients with heart failure with reduced left ventricular ejection fraction treated by general practitioners and cardiologists in contemporary Poland: "Шє results from the DATA-HELP registry. Int J. Cardiol. 2014;176 (3):852-8. DOI:10.1016/j. ijcard. 2014.08.005

6. Uthamalingam S., Kandala J., Selvaraj V. Martin W., Daley M., Patvardhan E. et al. Outcomes of Patients With Acute Decompensated Heart Failure Managed by Cardiologists Versus Noncardiologists. Am J. Cardiol. 2015;115 (4):466-71. DOI:10.1016/j. amjcard. 2014.11.034

7. Joynt KE, Orav EJ, Jha A.K. Physician Volume, Specialty, and Outcomes of Care for Patients With Heart Failure. Circ Heart Fail. 2013;6 (5 ) :890-7. DOI: 10.1161 /CIRCHEARTFAILURE. 112.000064

8. Ситникова М. Ю., Лясникова Е. А., Юрченко А. В., Трукшина М. А., Либис Р. А., Кондратенко В. Ю. и др. Результаты Российского госпитального регистра ХСН в 3 субъектах Российской Федерации. Кардиология. 2015;55 (10):5-13. DOI:10.18565/cardio. 2015.10.5-13

9. Арутюнов А. Г., Драгунов Д. О., Арутюнов Г. П., Рылова А. К., Пашкевич Д. Д., Витер К. В. и др. Первое открытое исследование синдрома острой декомпенсации СН и сопутствующих заболеваний в Российской Федерации. Независимый регистр ОРАКУЛ-РФ. Кардиология. 2015;55 (5):12-21. DOI: 10.18565/cardio. 2015.5.12-21

10. Арутюнов А. Г., Рылова А. К., Арутюнов Г. П. Регистр госпитализированных пациентов с декомпенсацией кровообращения (Павловский регистр). Сообщение 1. Современная клиническая характеристика пациента с декомпенсацией кровообращения. Клинические фенотипы пациентов. Журнал Сердечная Недостаточность. 2014;15 (1):23-32.

11. Adams KF, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: Rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005;149 (2):209-16. DOI:10.1016/j. ahj. 2004.08.005

12. Maggioni AP, Dahlström U., Filíppatos 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 Pi lot Survey (ESC-HF Pilot). Eur J. Heart Fail. 2013,15 (7):808-17. DOI:10.1093/eurjhf/hft050

13. Ambrosy AP, Fonarow GC, Butler J., Chioncel O., Greene SJ, Vaduganathan M. et al. The Global Health and Economic Burden of Hospitalizations for Heart Failure. J. Am Coll Cardiol. 2014,63 (12):1123-33. DOI:10.1016/j. jacc. 2013.11.053

14. Мареев В. Ю., Даниелян М. О., Беленков Ю. Н. Первые результаты национального эпидемиологического исследования. Эпидемиологическое Обследование больных ХСН в реальной практике (по Обращаемости) ЭПОХА-О-ХСН. Журнал Сердечная Недостаточность. 2003,4 (3):116-20.

15. Ситникова М. Ю., Борцова М. А., Иванов С. Г., Лелявина Т.А., Лясникова Е. А., Прокопова ЛВ и др. Этапы континуума для улучшения прогноза в разных подгруппах больны ХСН: от организации менеджмента и оптимизации программы физической реабилитации к уточнению доступных для исследования Ф.Р. Трансляционная Медицина. 2015, (5):62-72.

16. Lelyavina TA, Sitnikova MY, Galenko VL, Bortzova M.A. Аerobic training in heart failure patients with optimal heart failure therapy -a prospective randomized study. World J. Pharm Res. 2017,6 (2):59-67. DOI: 10.20959/wjpr20170-7673

17. Лелявина Т. А., Ситникова М. Ю., Галенко В. Л., Козлов П. С., Борцова М. А. Длительные аэробные тренировки способствуют развитию физиологического обратного ремоделирования миокарда у больных ХСН. Медицинский Алфавит. 2017,1 (13 (310)): 16-9.

18. Ситникова М. Ю., Федотов П. А., Лясникова Е. А., Трукшина М. А., Лелявина Т. А., Борцова МА и др. Современные принципы диагностики и лечения С.Н. Учебное пособие. -СПб.: Инфо-ра, 2018. 100 с.

19. 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 12440 patients of the ESC Heart Failure Long-Term Registry. Eur J. Heart Fail. 2013,15 (10):1173-84. DOI:10.1093/eurjhf/hft134

20. Виноградова Н. Г., Жиркова М. М., Фомин И. В., Поляков Д. С. Эффективность лечения ХСН на амбулаторном этапе в условиях городского центра ХСН. Журнал Сердечная Недостаточность. 2017,17 (4):270-8. DOI:10.18087/rhfj. 2017.4.2355

21. Bradley EH, Curry L., Horwitz LI, Sipsma H., Wang Y., Walsh MN et al. Hospital Strategies Associated With 30-Day Readmission Rates for Patients With Heart Failure. Circ Cardiovasc Qual Outcomes. 2013,6 (4):444-50. DOI:10.1161/CIRCOUTCOMES. 111.000101