Impact of drug therapy on long-term prognosis in patients with ischemic chronic heart failure with preserved ejection fraction and renal dysfunction

Abstract

Despite the achievements of recent decades, chronic heart failure (CHF) is one of the most widespread and steadily progressive disease which accompanied by high mortality. Aim. To investigate the effect of combined drug therapy for long-term prognosis in patients with ischemic heart failure with reduced ejection fraction of left ventricle and renal dysfunction. Materials and methods. The study involved 140 patients (114 (81.4%) men) with ischemic chronic heart failure; average age was 60 [54.5-68] years. Therapy included: ACE inhibitors/ARBs (90%), beta blockers (94.3%), diuretics (87.8%), statins (84.3%), mineralocorticoid receptor antagonists (75%), antiplatelet agents (70.7%), calcium antagonists (14.3%), amiodarone (18.6%), ivabradin (15%). The cumulative survival curves were constructed by the Kaplan-Meier method using and groups were compared with the log-rank test. Results. In our study it has been established that statins inclusion in the therapy of patients with ischemic heart failure with reduced ejection fraction of left ventricle and renal dysfunction reduces the risk of cumulative endpoint by 51% (hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.26 -0.91, p=0.02), prescription of trimetazidine - by 43% (HR 0.57, 95% CI 0.34-0.95, p=0.03), nitrates - by 47% (HR 0.53; 95% CI 0.31-0.89, p=0.01). Inclusion of mineralocorticoid receptor antagonists increased number of cardiovascular events during three years of monitoring (HR 1.88, 95% CI 1.21-2.94, p=0.005). Inclusion of aspirin reduced the risk of SCD by 75% (HR 0.25, 95% CI 0.12-0.53, p=0.0004). Inclusion of nitrates by 55% (HR 0.45, 95% CI 0.23-0.89, p=0.02) and statins by 68% (HR 0.32, 95% CI 0.14-0.72; p=0.006) reduced hospitalization. Conclusion. Based on three-year monitoring results of ischemic heart failure patients with reduced ejection fraction and renal dysfunction it has been found that the inclusion of statins, nitrates, trimetazidine to standard therapy was associated with reduced risk of cumulative endpoint and hospitalization caused by heart failure decompensation.