EPOCH-CHF As A Mirror of the Current Problems in Cardiovascular Diseases Treatment in Real Clinical Practice

Aim    To analyze the main reasons for the impairment of the life prognosis of patients with chronic heart failure (CHF) in real clinical practice of the Russian Federation.
Material and methods    Representative samples of the population of the Nizhny Novgorod region (1998, n=1,922) and the European part of Russia followed from 2002 through 2017 (n=19,276), as well as randomly selected medical records of outpatients under the dispensary monitoring for CHF from 19 therapeutic and preventive medical institutions of three constituent entities of the Russian Federation (n=177, 2022) were analyzed for the adherence to therapy and the effectiveness of treatment. In addition, the prevalence, etiology, and prognosis of life of patients with CHF and acute decompensated heart failure (ADHF) were determined as a part of the EPOCH study.
Results    The EPOCH-CHF study for the first time determined the true prevalence of CHF in the European part of the Russian Federation (8.2% by soft criteria) and 3.1% (by strict criteria). Furthermore, the prevalence of heart failure with reduced ejection fraction (EF) was 0.8%, moderately reduced EF was 0.9%, and heart failure with preserved EF was 1.4% of all studied patients in whom HF was defined by strict criteria. The EPOCH-CHF and EPOCH-Hospital Stage studies confirmed that a long-term exposure of the body to arterial hypertension and ischemic heart disease significantly influenced the development of CHF. At the same time, acute myocardial infarction, diabetes mellitus and uncorrected heart defects can induce severe CHF within a short period. The life prognosis of patients both after ADHF and with stable CHF in the Russian Federation is very poor. Within 4 years, 55.2% of patients after ADHF die; no patient with III-IV FC CHF survives longer than 10 years; and patients with I-II FC CHF are at a 75% risk to die after 16 years of follow-up. This is related with an ineffective use of basic drugs and uncoordinated follow-up of patients.
Conclusion    The analysis of three studies showed a high level of coverage of CHF patients with therapy but a low level of compliance with national guidelines, which is reflected in the use of low doses of drugs, the lack of effective hemodynamic control and, as a consequence, a poor prognosis for CHF patients with CHF, regardless of its stable course or acute decompensation.

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