Akut Kalp Yetmezliğinde Uygulanan Tedavilerin Mortalite Üzerine Etkisi: Bir Gerçek Dünya Çalışması

Öz

Amaç: Güncel tedavi uygulamalarıyla kronik sistolik kalp yetmezliği mortalitesinde azalma sağlanmıştır. Ancak akut kalp yetmezliğinde (AKY) mortalite hala yüksektir. Bizim çalışmamızda AKY hastalarında mortalite oranları ve mortalitenin ön gördürücülerinin neler olduğu araştırılmıştır. Materyal ve Metot: Çalışmamız Mart 2009 ve Haziran 2013 tarihleri arasında AKY tansıyla yatırılan 805 hastayı içeren tek merkezli retrospektif bir çalışmadır. Çalışmadaki hastalar iki ana gruba ayrıldı: pulmoner ödemin eşlik ettiği ya da etmediği sağ kalp yetmezliği kliniği ile başvuran hastaları içeren (722 hasta – %89,7) dekompanze kalp yermezliği (DKY) grubu, sadece pumoner ödem klinği ile başvuran hastaları içeren (83 hasta – %10,3) pulmoner ödem grubu (PÖ). İki grup arasında hastalara ait değişkenler istatiksel olarak karşılaştırıldı. Etiyolojiye göre ayrılmış hasta gruplarının sağ kalım analizi yapıldı. En sonda da AKY de 2 yıllık mortaliteyi öngören bağımsız faktörler araştırıldı. Bulgular: İki yıllık mortalite DKY grubunda PÖ grubundan daha fazlaydı (%51,4 ve %31,6 p<0,001). İskemik kardiyomiyopati, non iskemik kardiyomiyopati, korunmuş ejeksiyonlu kalp yetmezliği (kEFKY) hastalarında mortalite oranları sırasıyla %52,8, %39,6 ve %47,3 idi. (p: 0,389). İleri yaş, serebrovasküler olay öyküsü, anemi, hiponatremi, hipoalbuminemi, düşük sol ventrikül ejeksiyon fraksiyonu (SVEF), düşük sistolik kan basıncı 2 yıllık artmış mortaliteyi öngören bağımsız faktörler olarak bulunurken hastane yatışında beta bloker kullanımı mortaliteyi azaltan bağımsız faktör olarak bulundu. Sonuç: Mortalite oranları farklı kalp yetmezliği gruplarında benzer saptandı. Çeşitli klinik ve laboratuvar parametreleri AKY de mortaliteyi artıran öngördürücüler olurken beta bloker ve anjiyotensin dönüştürücü enzim (ADE) inhibitör kullanımı mortaliteyi azaltan öngördürücüler oldu.

Anahtar Kelimeler

• mortalite
• akut kalp yetmezliği
• ACE inhibitörü
• beta bloker

The Effect of the Practical Treatments for Acute Heart Failure on Mortality: A Real-World Study

Öz

Aim: The mortality of chronic systolic heart failure has been decreased thanks to state-of-the-art therapy. However, the mortality rate is still high in acute heart failure (AHF). Our study was planned to investigate the mortality rates and predictors of mortality in AHF. Material and Method: A single-center retrospective study was conducted on 805 patients hospitalized due to AHF between March 2009 and June 2013. The patients were separated into two main groups: the decompensated heart failure group (DHF), which comprised the patients with signs of right heart failure with or without pulmonary edema (722 patients – 89.7%), and the acute pulmonary edema group (PE) presenting only with pulmonary edema (83 patients – 10.3%). The two groups were compared for the patient-related variables. The survival analysis of the groups based on the etiology was performed. Finally, the independent predictors for 2-year mortality in AHF were investigated. Results: The 2-year mortality rate was higher in DHF than in PE (51.4% vs. 31.6% p<0.001). The mortality rates of ischemic cardiomyopathy, nonischemic cardiomyopathy, and heart failure with preserved ejection fraction (HFpEF) were 52.8%, 39.6%, and 47.3%, respectively (p=0.389). Advanced age, previous cerebrovascular diseases, anemia, hyponatremia, hypoalbuminemia, lower left ventricular ejection fraction (LVEF), and lower systolic blood pressure predicted increased 2-year mortality independently. In contrast, usage of beta-blockers during hospitalization predicted reduced 2year mortality independently. Conclusion: Mortality rate was similar between different heart failure types. Various laboratory and clinical parameters predict mortality, whereas beta-blockers and ACE inhibitors reduce mortality.

Anahtar Kelimeler

• mortality
• acute heart failure
• ACE inhibitors
• beta blockers

Kaynakça

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