Dept. of Cardiology, Shaheed Rajaie Cardiovascular Medical Center, Iran University of Medical Sciences and Health Services, Tehran, IranProfessor in Cardiology,
Cardiologist, Shaheed Rajaie Cardiovascular Medical Center, Iran University of Medical Sciences and Health Services, Tehran, Iran
Introduction: The clinical syndrome of heart failure (HF) remains a leading cause of cardiac morbidity and mortality. The coming years will see a continuous growth in the epidemic of HF and increasingly complex pharmacological, interventional, and device-based therapies, effective in reducing HF morbidity and mortality. Highly trained clinician-specialists are needed to assist in optimally evaluating and managing patients with HF.
Objective: The aim of the present study was to determine the best management protocol for HF by surveying different therapeutic protocols (medical, cardiac resynchronization therapy [CRT] program, and enhanced external counterpulsation [EECP]).
Methods: Initial assessment was performed for a total of 280 HF patients evaluated in the Heart Failure Clinic. Eighty patients were included in the study; the selection being done in accordance with the inclusion criteria of ejection fraction (EF) £35%. By surveying different therapeutic protocols, disease management programs (DPMs), namely medical, CRT, and EECP, were performed in three study groups: group A; medical therapy (n=37), group B; EECP (n=16), and group C; CRT (n=27). Changes in New York Heart Association (NYHA) functional class and echocardiographic indexes were evaluated in the three groups.
Results- There was no significant change in EF, left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), and E/E' ratio after medical therapy. There was, however, a significant improvement in NYHA function class (P <0.001). EECP significantly improved EF (P<0.05) and E/E' ratio (P<0.001). There was also a significant reduction in LVESV (P<0.05) with improvement in NYHA functional class and rehospitalization (P<0.001). CRT significantly reduced LVESV, LVEDV (P<0.05), E/E' ratio (P<0.001), and EF (P<0.001).There was improvement in NYHA functional class and rehospitalization as well (P<0.001).
Conclusion: Our findings suggest that disease management programs or guideline-based treatments reduce first hospitalization and rehospitalization rates in patients with heart failure and improve NYHA functional class and the echocardiographic findings of LVESV, LVEDV, LVEF, and E/E' ratio. In the hope of improving HF outcomes, disease management programs (medical care, EFCP, CRT-D implantation, etc.) have been developed to standardize and optimize HF treatment, focusing on disease education for the patient and continuing support after hospital discharge.