The thesis is devoted to increasing the effectiveness of hospitalisation forecasting in elderly patients with chronic heart failure (CHF) and impaired kidney function by identifying risk groups based on clinical and laboratory research data and a medication adherence level, and determining the impact of these factors on quality of life (QoL) and glomerular filtration rate (GFR).
To achieve the goal, 93 elderly patients (according to the WHO classification, 2015) with CHF II stage with the background of arterial hypertension (AH) stage II, grade 1-2, and impaired kidney function with GFR >45 ml/min/1,73 m2. The mean age was 64 [62; 68] years old, and the portion of men was 37,6% (35/93). The mean duration of hypertension was 8 [7; 10] years. At the time of inclusion in the study, shortness of breath was present in all the patients, feeling of rhythm disturbances – in 19,3%, and inability to be in a horisontal position – in 55,9%. On objective examination, all the patients had edema in the lower extremities, 21,5% of patients had jugular vein distension, and 49,5% had fine crackles over the lungs (a sign of left ventricular failure). The mean systolic blood pressure (SBP) was 155 [150; 163] mmHg, diastolic blood pressure (DBP) – 88 [79; 92] mmHg, heart rate (HR) – 74 [68; 79] beats per minute (bpm). The mean score on the Clinical Symptom Rating Scale (CSRS) was 5 [3; 7] points. The result of surveying with the Minnesota Living with Heart Failure Questionnaire was found to be 50 [39; 61] points. The mean trends of the creatinine were 92 [88; 99] mmol/l, GFR – 61,1 [56,6; 68] ml/min/1,73 m2. The proportion of patients with GFR <60 ml/min/1,73 m2 was 45,2%. During the echocardiographic study, the ejection fraction (EF) was 61,3 [56; 67,8] %, left ventricular myocardial mass index (LV MMI) – 110 [100,7; 130,6] g/m2, the left atrium size (LA) – 4,1 [3,9; 4,3] cm.
The scientific novelty of the results obtained. It was shown that in patients with CHF and impaired kidney function at a GFR <60 ml/min/1,73 m2, non-adherence to treatment leads to a statistically significantly worse indicator of exercise tolerance, determined using 6MWT, compared to patients in whom GFR ≥60 ml/min/1,73 m2. The relationship between the GFR indicator and the medication adherence level, the number of points on the CSRS, and the distance covered during 6MWT were established and substantiated. The concept of prognostic factors for the GFR deterioration during a year in patients with CHF on the background of AH and impaired kidney function has been expanded. Clinical and laboratory factors associated with the QoL score in the specified cohort of patients were determined. The existence of a relationship between the medication adherence level and the QoL score was established and justified. It has been proven that the level of SBP in patients with CHF on the background of AH and impaired kidney function is a factor that determines the relationship between medication adherence and QoL. Based on the study results of the patients cohort with CHF on the background of AH and impaired kidney function, the data on prognostic risk factors of hospitalisation for CHF during the next 6 months were supplemented, and a prognostic model was also built to determine the probability of the specified adverse event.
The practical significance of the results obtained. To identify patients from the risk group of renal function decline, it is recommended to determine medication adherence using the Morisky-Green scale and exercise tolerance using 6MWT. If ≤2 scores are obtained according to the Morisky-Green scale and the distance covered is ≤321 m, the patient should be classified as a risk group. To improve the QoL of CHF patients with a background of AH and impaired kidney function, it is recommended to increase medication adherence, especially to antihypertensive therapy. It is recommended to use the developed prediction model, which includes indicators that are easy to obtain in an outpatient setting (NYHA FC, presence of chronic left ventricular failure (auscultation of fine crackles over the lungs), GFR and medication adherence level) to identify patients at risk of hospitalisation within the next 6 months in order to monitor and early correct the detected violations.
