[Polymorbidity and its association with the unfavorable course of chronic heart failure in outpatients aged 60 years and older].

AIM: This study was carried out to evaluate polymorbidity taking into account geriatric syndromes and their relationship with the course of chronic heart failure (CHF) in outpatients aged 60 years and older. Methods. We conducted an open, prospective, non-randomized study. The main group included 80 patients with CHF, the comparison group - 40 patients without CHF. Conducted clinical examination, ECG, echocardiography, two-photon X-ray absorptiometry. The scale of assessment of clinical status in CHF,Charlson comorbidity index were used. The criteria for frailty were the presence of at least 3 signs due FRAIL scale. Mean follow-up was 24.1±13.0 months. Results. All patients with CHF (100%) and 92.5% of the comparison group had a concomitant pathology. A combination of 3 or more of any diseases was more common in CHF compared to control group (p=0.008), CKD (66%) and obesity (35%) were the most common pathology. Combinations of osteoporosis and CKD (28%), obesity and CKD (23%) were the most frequent in the CHF patients, a combination of obesity and CKD (28%), obesity and diabetes (18%) - without CHF patients. The same incidence of osteoporosis (p=0.768), falls (p=0.980), fractures (p=0.549) and frailty (p=0.828) was observed in CHF patients and different EFLV, but prevalence of frailty was observed at the age of 75 years and older. During the observation period, 24% CHF patients and 5% patients without CHF (p=0.022) died. The worst survival of patients with ischemic genesis of CHF and osteoporosis was noted. The factors associated with an increased risk of death in CHF patients were the ischemic etiology of CHF (OR 8.33; 95% CI 1.11-62.4; p=0.039), male gender (OR 7.91; 95% CI 2.3-27.2; p=0.001), LV EF <45% (OR 2.52; 95% CI 1.01-6,27; p=0.047), low bone mineral density in femoral neck region (р=0.016, ОR 4.3, 95% CI 1.3-17.2), comorbidity score (OR 1.19; 95% CI 1.04-1.37; p=0.012), a total score on the scale of assessment of clinical status in CHF (OR 1.13; 95% CI 1.03-1.24; p=0.008). Conclusion. All СHF patients had concomitant diseases, CKD and obesity were the most common pathologies. The ischemic etiology of CHF, along with the male gender, LV EF less than 45%, severe clinical statusand high score on the Charlson comorbidity index turned out to be risk factors for death in outpatients aged 60 years and older with CHF.

[Specific Features of Pharmacotherapy of Patients With Chronic Heart Failure and Preserved Left Ventricular Ejection Fraction].

The review is devoted to pharmacotherapy of chronic heart failure (CHF) with preserved left ventricular ejection fraction. In this review we discuss data of meta-analyzes of randomized clinical trials and observational studies, as well as the indications for use of inhibitors of the renin-angiotensin-aldosterone system, ß-blockers, and antagonists of mineralocorticoid receptors in these patients in current clinical guidelines. New approaches to therapy of CHF from the perspective of influence on myocardial fibrosis are considered in this review.

Bendopnea: Association With Echocardiographic Features and Clinical Outcomes in Elderly Patients With Chronic Heart Failure.

AIM: to assess the prevalence of bendopnea and association of this symptom with clinical, laboratory and echocardiographic features, clinical outcomes during 2 years of follow-up in ambulatory elderly patients with chronic heart failure (CHF). MATERIALS AND METHODS: We conducted an open, prospective, non-randomized study of 80 ambulatory patients aged ≥60 years admitted with heart failure II-IV NYHA class CHF. Baseline survey included physical examination, estimation of Charlson comorbidity index, echocardiography and laboratory tests. Bendopnea was considered when shortness of breath occurred within 30 sec of sitting on a chair and bending forward. Mean follow-up was 26.6±11.0 months. RESULTS: Bendopnea was present in 38.8 % patients. All these patients complained of shortness of breath during physical exertion and 45.2 % of them had orthopnea.  Bendopnea was associated with the male gender (odds ratio [OR] 11.8, 95 % confidence interval [CI] 4.04-34.8, p<0.001), severity of the clinical status (ШОКС [shocks] scale score)  (OR 1.78, 95 % CI 1.29-2.38, p<0.001), Charlson comorbidity index (OR 1.29, 95 % CI 1.07-1.52, p=0.007), coronary heart disease (OR 26.6, 95 % CI 3.34-21.3, p=0.002), history of myocardial infarction (OR 13.9, 95 % CI 4.2-46.6, p<0.001), left ventricular (LV) aneurysm (OR 13.3, 95 % CI 2.69-65.9, p=0.002), increased indexed LV end-systolic diameter (OR 8.2, 95 % CI 1.9-34.1, p=0.004), left atrial size (OR 4.3, 95 % CI 1,4-12.5, p=0.008), indexed LV end-systolic volume (OR 1.32, 95 % CI 1.07-1.64, p=0.010), pulmonary artery systolic pressure (OR 1.26, 95 % 1.03-1.45, p=0.002), high levels of NT-proBNP (OR 1.0, 95 % CI 1.0-1.002, p=0.055), creatinine (OR 1.04, 95 % CI 1.02-1.07, p=0.001), uric acid (OR 1.006, 95 % CI 1.002-1.011, p=0.004); hospitalizations (OR 7.61, 95 % 2.04-28.4, p=0.003), and patient's mortality (OR 5.63, 95 % CI 1.94-16.4, p=0.001). Multifactorial analysis confirmed association of bendopnea with severity of clinical status (OR 1.70, 95 % CI 1.04-2.8, p=0.033), increased left atrial size (OR 5.67, 95 % CI 2.75-21.32, p=0.029) and Charlson comorbidity index (OR 1.17, 95 % CI 1.04-2.80, p=0.050). During follow-up 51.6 and 12.2 % of patients died among those with and without bendopnea, respectively (OR 4.22, 95 % CI 1.85-9.9, p<0.001). CONCLUSION: Bendopnea is associated with an adverse hemodynamic profile and prognosis, what allows to consider this symptom as a reliable marker of CHF severity.

[Medication Adherence of Elderly Patients With Chronic Heart Failure].

The review is devoted to the problem of medication adherence in elderly patients with chronic heart failure. We consider here specificity of approach to management of elderly outpatients, groups of factors associated with medication adherence, and possible ways to improvement of compliance to treatment in patients from the senior age group with heart failure.

[Risk of Cardiovascular Complications and Geriatric Syndromes Among Elderly Women].

AIM: to assess the prevalence of some geriatric syndromes and their association with high risk of cardiovascular complications (RCVC) among elderly women. MATERIAL AND METHODS: We examined 72 women aged 69-77 years with cardiovascular diseases. Examination included laboratory and echocardiography assessment, dual-energy X-ray absorptiometry, 6-min walk test, assessment of psycho-emotional status using Mini-mental State Examination (MMSE) questionnaire. Frailty was defined as three or more of the following: weight loss, low physical activity levels, MMSE less or equal 23 points, weakness (chair stand test>10 sec), history of multiple falls. Follow up was 7.3 (5.5-7.8) months. RESULTS: High CVR was found in 70.8% women: in 59.1% women aged 65-74 years and in 89.3% - aged more or equal 75 years, =0.006. Osteoporosis (OP) was found in 51.3% women aged 65-74 and in 90.5% - aged more or equal 75 years, =0.024; MMSE was 27 (24-28) vs 24 (20-26) points, respectively, =0.008. The geriatric syndrome of frailty was found in 13.6% women aged 65-74 and in 64.3% - aged more or equal 75 years. Frailty was associated with high CVR (odds ratio [R] 7.2, 95% confidence interval [CI] 1.5-34.2, =0.013), chronic kidney disease (CKD, R 18.9, 95%CI 5.2-20.2, <0.001), P (R 4.5, 95%CI 1.3-15.8, =0.019), history of myocardial infarction (MI, R 6.8, 95%CI 2.2-20.8, =0.001), greater age (R 6.0, 95%CI 2.1-17.5, =0.001). CONCLUSION: High CVR was prevalent among greater age women what could be explained by prevalence of chronic heart failure, atrial fibrillation, CKD. Prevalence of frailty was 13.6 and 64.3% among women aged 65-74 and more or equal 75years, respectively. It was significantly associated with high CVR, OP, PMI, CKD.