Понятие стабильности течения ХСН – приемлемо ли оно для российской практики?

Abstract

To evaluate preparedness of physicians in real clinical practice to strive for stabilizing the course of CHF by control of clinical and hemodynamic indexes both in prevention of admission for decompensated CHF and following discharge from the hospital. The study included 750 CHF patients with any NYHA FC who were admitted in emergency for decompensated CHF. All patients with CHF were followed up for a year after discharge from the hospital. Medical records of inpatients (MRIP) and outpatients (MROP) were analyzed including determination of clinical symptoms and administered doses of medicines. Changes in clinical parameters during a year were recorded. CHF decompensation was evident as pulmonary edema in 1.6% of cases and acute left ventricular failure in 18.5% of cases. All the rest of decompensated CHF cases included ascites or hyposarca (21.1%), or increased edema syndrome with unstable hemodynamics (58.5%). In MROPs, weight control was presented for 1.2% of patients. The composite index of effectively achieved control of hemodynamics and body weight was only 0.2%. Treatment effectiveness decreases due to absence of drug titration and switching therapies, which considerably impairs prognosis for patients. Outpatient physicians lack alertness for development of CHF decompensation, and control of hemodynamics and body weight of patients remains ineffective. Physicians are not prepared to achieve recommended doses of medicines, which provokes high risk of fatal outcome and/or rehospitalization.