Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


Aim. To identify risk factors of decompensation of chronic heart failure (CHF) and related hospitalization in elderly outpatients.

Material and methods. The total of 248 patients aged 60–85 years with CHF NYHA class II-IV were enrolled into the study. The first group consisted of 87 (35.1%) patients who required hospitalization due to CHF decompensation during the follow-up, the second group of 161 patients without need for hospital admission. All the patients had undergone clinical and laboratory examination, estimation of CHF severity by the Scale of clinical state, assessment of quality of life and 6-minute walk test (6MWT), echocardiography.

Results. Patients were matched for age, gender, disability occurrence, education level, body mass index, quality of life, hemodynamic parameters, incidence rates of anemia, diabetes mellitus and atrial fibrillation. CHF was more severe in patients who had required hospitalization (p<0.001), they were more often diagnosed with left ventricular aneurysm (p=0.001), chronic kidney disease (p=0.001), left ventricular ejection fraction (LVEF)<35% (p<0.001), history of stroke (p<0.001), III-IV degree mitral regurgitation (p=0.007), hyperuricemia (p<0.001), lower exercise tolerance (p=0.007) compared with patients without hospitalization. Higher functional class of CHF (OR=0.29; 95% CI 0.13–0.69; p=0.003), LVEF<35% (OR 0.37; 95% CI 0.18–0.76; p=0.007), chronic kidney disease (OR=0.29; 95% CI 0.13–0.68; p=0.004) and hyperuricemia (OR=0.23; 95%CI 0.10–0.50; p<0.001) were shown to be independent risk factors of CHF decompensation that required hospital admission in elderly patients.

Conclusuion. High FC of CHF, low LVEF, hyperuricemia and renal dysfunction play a key role in CHF decompensation and related hospitalization in elderly patients.

About the Authors

V. N. Larina
Russian National Research Medical University named after N.I. Pirogov, Moscow
Russian Federation
Vera N. Larina – PhD, MD, Professor of Chair of Outpatient Therapy №1, Faculty of General Medicine

B. Ya. Bart
Russian National Research Medical University named after N.I. Pirogov, Moscow
Russian Federation
Boris Y. Bart PhD, MD, Professor, Head of Chair of Outpatient Therapy №1, Faculty of General Medicine

E. A. Vartanyan
Russian National Research Medical University named after N.I. Pirogov, Moscow
Russian Federation
Elena A. Vartanyan PhD, MD, Associate Professor of Chair of Outpatient Therapy №1, Faculty of General Medicine


1. Belenkov Yu.N., Mareev V.Yu., Ageev F.T. et al. Etiological causes of the formation of CHF in the European part of the Russian Federation (hospital phase). Serdechnaya Nedostatochnost' 2011; 6(68): 333– 338. Russian. (Беленков Ю.Н., Мареев В.Ю., Агеев Ф.Т. и др. Этиологические причины формирования ХСН в Европейской части Российской Федерации (госпитальный этап). Сердечная Недостаточность 2011; 6(68): 333–338).

2. National guidelines for the diagnosis and treatment of chronic heart failure (third revision). Serdechnaya Nedostatochnost' 2010; 11(57): 3–63. Russian (Национальные рекомендации по диагностике и лечению хронической сердечной недостаточности (третий пересмотр). Сердечная Недостаточность 2010; 11(57): 3–63)

3. Dickstein K., Cohen-Solal A., Filippatos G., McMurray J. et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008; 29:2388–2442

4. Cleland J., Cohen-Solal A., Aguilar J. et al. Management of heart failure in primary care (the IMPROVEMENT of heart Failure Programme): an international survey. Lancet 2002; 360: 1631–9.

5. Fomin I.V., Belenkov Yu.N., Mareev V.Yu. i dr. The prevalence of heart failure in the European part of the Russian Federation — the EPOHA-HSN data. Serdechnaya Nedostatochnost' 2006; 1 (35): 4–7. Russian (Фомин И.В., Беленков Ю.Н., Мареев В.Ю. и др. Распространённость ХСН в Европейской части Российской Федерации — данные ЭПОХА-ХСН. Сердечная Недостаточность 2006; 1 (35): 4–7).

6. Storozhakov G.I., Gendlin G.E. The main directions in the treatment of patients with chronic heart failure. Moscow: Miklos; 2008. Russian (Сторожаков Г.И., Гендлин Г.Е. Основные направления в лечении больных хронической сердечной недостаточностью. Москва: Миклош; 2008).

7. Hunt A., Abraham W., Chin M. et al. ACC/AHA 2005 Guidelines update for the diagnosis and management of chronic heart failure in the adult — summary article. J Am Coll Cardiol 2005; 46:1116– 43.

8. Ross J., Chen J., Lin Z. et al. Recent national trends in readmission rates after heart failure hospitalization. Circ Heart Fail 2010;3:97–103.

9. Fang J., George A., Mensah G., et al. Heart Failure-Related Hospitalization in the U.S., 1979 to 2004. J Am Coll Cardiol 2008; 52: 428–434.

10. Zhang W., Doherty M., Pascual E. et al. EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the standing committee for international clinical studies including therapeutics (ESCISIT). Ann Rheum Dis 2006; 65:1301–1311.

11. Levey A., Coresh J., Greene T. et al. Chronic Kidney Disease Epidemiology Collaboration. Expressing the Modification of Diet in Renal Disease Study Equation for Estimating Glomerular Filtration Rate with Standardized Serum Creatinine Values. Clin Chem 2007;53(4):766–72.

12. The National Kidney Foundation KD/OQI: Clinical Practice Guidelines for chronic kidney disease: Evaluation, сlassification and stratification. Am J Kidney Dis 2002; 39 (Suppl.1): S1-S266.

13. Belenkov J.N., Mareev V.Y., Ageev F.T. et al. The first results of a national epidemiological study — epidemiological study of patients with CHF in real practice (referral) — the EPOHA-O-HSN study. Serdechnaya Nedostatochnost' 2003; 3 (3):116–120. Russian (Беленков Ю.Н., Мареев В.Ю., Агеев Ф.Т. и др. Первые результаты национального эпидемиологического исследования — Эпидемиологическое обследование больных ХСН в реальной практике (по обращаемости) — ЭПОХА-ОХСН. Сердечная Недостаточность 2003; 3 (3):116–120).

14. Rebrov A.P., Kosheleva N.A. Effect of therapeutic training and active outpatient management on clinical state and cardiovascular complications in patients with chronic heart failure (three year followup). Rational Pharmacother Card 2011;7(3):275–287. Russian (Ребров А.П., Н.А. Кошелева Н.А. Влияние терапевтического обучения и активного амбулаторного ведения пациентов с ХСН на их клиническое состояние и сердечно-сосудистые осложнения (трехлетнее наблюдение). РФК 2011;7(3):275–287).

15. Mirabel M., Lung B., Baron G. et al. What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J 2007; 28:1358–1365.

16. Bohm M., Kilter H., Kindermann M. Mechanisms contributing to the progression of left ventricular dysfunction to end-stage heart failure. Eur Heart J Suppl 2003; 5 (Suppl 1):114–121.

17. Bursi F., Enriques-Sarano M., Nkomo Y. et al. Heart Failure and Death after myocardial infarction in the community. The emerging role of mitral regurgitation. Circulation 2005; 111: 295–301.

18. Koelling T., Aaronson K., Cody R. et al. Prognostic sighnificance of mitral regurgitation and tricuspidal regurgitation in patients with left ventricular systolic dysfunction. Am Heart J 2002; 144 (3):524–529.

19. Ngaage D., Schaff H. Mitral valve surgery in non-ischemic cardiomyopathy. J Cardiovasc Surg 2004; 45:477.

20. Serov V.A., Shutov A.M., Suchkov V.N. i dr. Effect of chronic kidney disease on prognosis of patients with chronic heart failure. Serdechnaya Nedostatochnost' 2009; 4(54): 202–204. Russian (Серов В.А., Шутов А.М., Сучков В.Н. и др. Влияние хронической болезни почек на прогноз больных хронической сердечной недостаточностью. Сердечная Недостаточность 2009; 4(54): 202–204).

21. Silva R., Nikitin N., Witte K. et al. Incidence of renal dysfunction over 6 months in patients with chronic heart failure due to left ventricular systolic dysfunction: contributing factors and relationship to prognosis. Eur Heart J 2006; 27: 569–581.

22. Hediger M., Johnson R., Miyazaki H. Molecular physiology of urate transport. Physiology 2005; 20: 125–133.

23. Gladkikh A.S., Savina N.M., Kudinova S.P. et al. Readmissions of patients with chronic heart failure, according to a one-year follow-up. Kardiologiia 2009; (6): 31–35. Russian (Гладких А.С., Савина Н.М., Кудинова С.П. и др. Повторные госпитализации больных с хронической сердечной недостаточностью по данным одногодичного наблюдения. Кардиология 2009; (6): 31–35).

24. Leyva F., Anker S., Godsland I. et al. Uric acid in chronic heart failure: a marker of chronic inflammation. Eur Heart J 1998; 19:1814–1822.

25. Kang D., Park S., Lee I., Johnson R. Uric acid-induced C-reactive protein expression: implication on cell proliferation and nitric oxide production of human vascular cells. J Am Soc Nephrol 2005;16: 3553– 3562.

26. Gullu H., Erdogan D., Caliskan M. et al. Elevated serum acid level impair coronary microvascular function in patients with idiopathic dilated cardiomyopathy. Eur J Heart Fail 2007; 9:466–468.

27. Franse L., Pahor M., Di B. et al. Serum uric acid, diuretic treatment and risk of cardiovascular events in the Systolic Hypertension in the Elderly Program (SHEP). J Hypertens 2000;18:1149–1154.

28. Larina V.N., Bart B.Ya., Brodskiy M.S. Clinical and prognostic significance of hyperuricemia in patients with chronic heart failure in elderly patients. Serdechnaya Nedostatochnost' 2011: 5 (67); 277–281. Russian (Ларина В.Н., Барт Б.Я., Бродский М.С. Клиническое и прогностическое значение гиперурикемии при хронической сердечной недостаточности у больных пожилого возраста. Сердечная Недостаточность 2011: 5 (67); 277–281).

29. Wasserman A., Shnell M., Boursi B., Guzner-Gur H. Prognostic significance of serum uric acid in patients admitted to the department of medicine. Am J Med Sci. 2010; 339(1):15–21.

30. Manzano L., Babalis D., Roughton M. et al. Predictors of clinical outcomes in elderly patients with heart failure. Eur J Heart Fail 2011; 13:528–536.

31. Shafazand M., Schaufelberger M., Lappas G. et al. Survival trends in men and women with heart failure of ischaemic and non-ischemic origin: data for the period 1987–2003 from the Swedish Hospital Discharge Registry. Eur Heart J 2009; 30: 671–678.

32. Parameschwar J., Pool-Wilson P., Sutton G. Heart failure in district general hospital. J R Coll Physicians 1992; 26(2): 139–142.

33. Solomon S., Dobson J., Pocock S. et al. Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure. Circulation 2007; 116:1482–1487.

For citation:

Larina V.N., Bart B.Y., Vartanyan E.A. FACTORS EFFECTING THE DECOMPENSATION OF CHRONIC HEART FAILURE IN THE ELDERLY. Rational Pharmacotherapy in Cardiology. 2013;9(1):15-24. (In Russ.)

Views: 465

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)