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Effects of long-term treatment with Bisoprolol and Carvedilol on quality of life of patients with chronic heart failure
Kamilova Umida Kabirovna, Alieva Tohira Avazhanovna, Republican Specialized Scientific Practical Medical Centre of Therapy and Medical Rehabilitation, Tashkent Medical Academy, Uzbekistan
E-mail: umida_kamilova@ mail.ru
Effects of long-term treatment with Bisoprolol and Carvedilol on quality of life of patients with chronic heart failure
Abstract: The purpose of the present research was to study the assess the impact of bisoprolol and carvedilol on quality of life of patients with chronic heart failure (CHF). Long-term treatment with beta-blockers has a positive effect on the parameters of the quality of life in patients with CHF.
Keywords: chronic heart failure, quality of life, beta-blockers, long-term treatment.
Chronic heart failure (CHF) is not only a medical but also a social challenge due to significant prevalence, high mortality rates [1; 2]. Myocardial infarction (MI) is one of the main causes of HF. Despite the large number of studies on prognosis after myocardial infarction, heart failure in the literature still debated question of the prognostic significance of a number of indicators: postinfarction remodeling with the assessment of systolic and diastolic left ventricular function, myocardial viability, heart rhythm disorders, vascular remodeling, neurohumoral factors, which largely determine the severity of the clinical course, prognosis and the quality of life of patients [3; 4; 5]. This pathology sharply worsens the quality of life of patients and increases the risk of death in 4 times: it can vary from 15 to 50 % during a year. The risk of sudden death in patients with CHF is 5 times higher than in those without heart failure [6; 7]. About 50 % ofpatients with CHF, despite the use of combination therapy, die within 5 years after the onset of clinical symptoms [8; 9]. Use of beta-blockers opened a new era in treatment of CHF patients. Many studies, including long-term multicenter studies, determined that this drug group has a positive impact on the clinical course, the quality of life, and the prognosis of post-MI patients and patients with heart failure [10; 11].
The aim of the research: to study the comparative effectiveness of prolonged use of beta-blockers: cardioselec-tive — bisoprolol and non-selective carvedilol with a1-, ^1-and p2-blocking properties on clinical course and the quality of life in patients with chronic heart failure during long-term follow-up.
Materials and Methods. The study included 172 male patients post-MI patients with CHF between the ages of 40 to 55 (mean age 47.7 ± 6.1 yrs), who were treated at the cardiology department of Tashkent Medical Academy. Patients were randomized into groups with CHF functional class (FC) by the New York Heart Association (NYHA) classification according to 6-minute walk distance (6 MWD) and the Russian scale of evaluation of the clinical condition of the patients (Mareev V Yu., 2000). All patients were divided into three groups by functional class (FC) CHF: 35 patients with CHF I FC, 70 patients with CHF II FC and 75 patients with CHF III FC.
We reviewed the quality of life (QoL) in patients with chronic heart failure by the Minnesota Living with Heart Failure questionnaire (MLHFQ), suggested by T. Rector and J. Cohn (1985). The symptoms were assessed by 0-4 score, where 0 — no symptoms, 4 — its maximal occurrence. Functional status of the patient was assessed by DASI (The Duke Activity Status Index,1989), the total of indicators of which was named by authors as an index of activity. Questionnaires screened originally after 6 months of treatment. There considered the total of scores on each questionnaire within the clinical course.
To assess the dynamics of the studied parameters during long-term therapy with beta-blockers, patients were divided into 2 groups: in 1st group — 83 patients who received beta-blocker — bisoprolol in the complex treatment, in 2nd group — 89 patients who received carvedilol, nonselective beta-blocker with a1-, ^1-and p2-blocking properties. The mean daily dose of bisoprolol given to Group 1 patients was 10 mg.; the mean daily dose of carvedilol in Group 2 patients ranged from 25 to 50 mg. The standard therapy includes spironolactone, ACE inhibitors, antiplatelet agents. Exclusion criteria were diabetes, atrial fibrillation, COPD, asthma, and acute stroke.
Results were statistically processed using the software package Statistica 6.1 for Windows and the Excel package of Microsoft Excel 2007. The mean (M) and Standard Deviation (SD) were deduced. For data with normal distribution, inter-group comparisons were performed using Student’s t-test and F-test. The mean (M) and standard error of the mean (m) were calculated. Pearson’s Correlation Coefficient (r) was used to determine the strength of the relationship between the two continuous variables. Spearman’s rank correlation coefficient was also used. A probability value of P < 0.05 was considered statistically significant.
Results and Discussion. Evaluation of clinical status and quality of life (QoL) of patients after myocardial infarction. Indicators of exercise tolerance in patients examined in patients with CHF FC I made based on the results of 6MWD were 417.4 ± 17.89 meters. Patients with CHF FC II and III showed a decrease in exercise tolerance by 18 % and 44 % as compared with the patients with CHF 6MWD FC I, representing 346.1 ± 19.25 and 237.9 ± 20.55 meters, respectively.
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Section 8. Medical science
Baseline values of SCC in the patients with CHF FC I made 4.4 ± 1.33 scores, respectively. In patients with heart failure class II worsened clinical status of patients with increased performance SCC by 25 % compared with patients with CHF of I FC SCC (P < 0.001), accounting for 5.5 ± 0.70 scores, respectively. In patients with CHF FC III, this indicator was — 8.4 ± 0.83 scores or 90 % higher compared to SCC in patients with CHF FC I.
Baseline values QoL by the Minnesota questionnaire showed that the total index in patients with CHF FC I amounted — 26.5 ± 2.21 scores, in patients with class II CHF — 39.1 ± 3.23 and III CHF FC — 45.6 ± 2.75 scores, while it was significantly inversely correlated with the results obtained during 6MWD (r = -0.92). Baseline values of the total QoL index increases with CHF FC.
Analysis of ejection fraction (EF), 6 MWD and QoL parameters showed authentic direct dependence distance of 6 MWD from EF (r = 0.953), high inverse correlation between EF and QoL index by Minnesota questionnaire (r = -0.934).
Quality of life and prognosis of patients with CHF complicated by heart failure during long-term follow-up. The results of parameter estimation for the Minnesota QoL questionnaire in the surveyed patients showed that in patients treated with bisoprolol showed statistically significant reduction in the total index of QoL in patients with CHF FC I 31 % (P < 0.01) and CHF FC II — 34.9 % (P < 0.001) after 6 months oftreat-ment, respectively, compared with baseline. Long-term therapy with bisoprolol in patients with FC III CHF accompanied by a decrease QoL index by 29.7 % (P < 0.05) at 6 months compared with baseline.
The results of parameter estimation for the Minnesota QoL questionnaire in the surveyed patients showed that
in patients treated with carvedilol showed statistically significant reduction in the total index of QoL in patients with CHF FC I 33 % (P < 0.001) and CHF FC II — 36.8 % (P < 0.001) after 6 months of treatment, respectively, compared with baseline. Long-term therapy with carvedilol in patients with FC III CHF accompanied by a decrease QoL index by 40.1 % (P < 0.001) at 6 months compared with baseline.
The course of bisoprolol allowed significantly increase the activity index in patients with CHF FC I after 6 months of 25.3 % (P < 0.001) compared with baseline. In patients with heart failure class II after 6 months of treatment indicators of functional activity increased 2.4 times, accounting for 123 % of baseline (P < 0.001). An index of activity in patients with FC III heart failure increased by 131 % (P < 0.001) after 6 months of treatment, respectively, compared with baseline.
In the carvedilol group also noted the positive dynamics in the activity index in patients with CHF FC I by 31 % (P < 0.001) after 6 months of treatment, respectively, from the original. After six months therapy with carvedilolol in patients with class II CHF indicators of functional activity increased 2.8 times, amounting to 26.9 % (P < 0.05) from baseline. In dynamics of observation after 6 months in patients with FC III CHF refractive functional activity by DASI questionnaire increased — by 39.1 % (P < 0.001), respectively, from baseline.
We evaluated the forecast in the studied groups of patients. The analysis showed that in 3 years of follow-noted development reinfarction in 38 (22.1 %) cases, including 12 fatal and nonfatal 26, and 11 cases of sudden death.
Conclusion. Long-term treatment with beta-blockers has a positive effect on the parameters of the quality of life in patients with CHF.
References:
1. Gheorghiade M., Vaduganathan M., Fonarow G. C., Bonow R. O. Rehospitalization for heart failure: problems and
perspectives.//} Am Coll Cardiol. - 2013. - 61 (4): 391-403.
2. Ahmed A., Allman R. M., Fonarow G. C. Incident heart failure hospitalization and subsequent mortality in chronic heart failure: a propensity-matched study.//J. Card. Fail. - 2008. - № 14. - P. 211-218.
3. Dunlay S. M., Weston S. A., Killian J. M. et al. Thirty-day rehospitalizations after acute myocardial infarction: a cohort study.//Ann Intern Med. - 2012. - № 1. -P. 11-18.
4. Engelfriet P. M., Hoogenveen R. T., Boshuizen H. C., Baal van P. H. To die with of from heart failure: a difference that counts: is heart failure underrepresented in national mortality statistics?//Eur J Heart Fail. - 2011. - (13): 377-38.
5. Habal M. V., Liu P. P., Austin P. C. et al. Association of heart rate at hospital discharge with mortality and hospitalizations in patients with heart failure.//Circ Heart Fail. - 2014. - № 7. - Р. 12-20.
6. Iqbal J., Francis L., Reid J. et al. Quality of life in patients with chronic heart failure and their carers: a 3-year follow-up study assessing hospitalization and mortality.//J Heart Fail. - 2010, Sep. -12 (9): 1002-8.
7. Kato N., Kinugawa K., Seki S. et al. Quality of life as an independent predictor for cardiac events and death in patients with heart failure.//Circ J. - 2011. - 75 (7): 1661-9.
8. Yamokoski L. M., Hasselblad V., Moser D. K. et al. Prediction of rehospitalization and death in severe heart failure by physicians and nurses of the ESCAPE trial//J Card Fail. - 2007. - № 13. - Р. 8.
9. Maggioni A. P., Anker S. D., Dahlstrom U. et al. Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12,440 patients of the ESC Heart Failure LongTerm Registry.//J Heart Fail. - 2013. - Vol. 15. - Р 1173-1184.
10. Van der Leeuw J. Personalized cardiovascular disease prevention by applying individualized prediction of treatment ef-fects.//Eur Heart J. - 2014. - № 13. - P. 837-843.
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Comparative efficacy emergency endoscopic sclerotherapy in the treatment of bleeding from the varices of esophagus...
11. Wikstrand J., Wedel H., Castagno D., McMur-ray J. J. The large-scale placebo-controlled beta-blocker studies in systolic heart failure revisited: results from CIBIS-II, COPERNICUS and SENIORS-SHF compared with stratified subsets from MERIT-HF.//J Intern Med. - 2014. - Vol. 275, № 2. - Р. 134-143.
Karimov Shavkat Ibragimovich, MD, Academician of MS, Professor of the Surgery Department
of Tashkent Medical Academy Khakimov Murod Shavkatovich, MD, Professor, Head of the Surgery Department Matkuliev Utkirbek Ismoilovich, PhD. Assistant of the Surgery Department E-mail: inter.dep@mail.ru
Comparative efficacy emergency endoscopic sclerotherapy in the treatment of bleeding from the varices of esophagus and stomach. The urgency of the problem
Abstract:
Purpose: Evaluating the effectiveness of endoscopic sclerotherapy of the varicose veins in patients with portal origin bleeding from esophagus and stomach in different periods.
Results of treatment: In 108 patients with complicated liver cirrhosis with portal hypertension (PH) and bleeding from varicose veins (VV) in esophagus and stomach that were hospitalized into the 2nd clinic of the Tashkent Medical Academy in 2008-2011.
For a comparative analysis all the patients were divided into 2 groups. Control group consisted of 57 (52.7 %) patients with esophageal and gastric bleeding from VV, who delayed endoscopic sclerotherapy 2-3 days after admission, controlled bleeding with Blackmore probe obturator and performed intensive conservative therapy. The study group included 51 (47.3 %) patients with esophageal and gastric bleeding from VV, who performed emergency endoscopic sclerotherapy after admission at an altitude of bleeding or even stopped the bleeding in the event of a subsequent installation of Blackmore probe.
Recurrence of bleeding contained in 8 (15.7 %) patients. It should be noted that rebleeding observed only in patients with grade III varices with the transition into the stomach, while the control group of patients with recurrent bleeding heterogeneous in degree of varicose veins.
6 patients underwent re-sclerotherapy with the installation of the probe-obturator. In 2 patients performed operation by Sugiura due to profuse bleeding.
The mortality rate was 11.8 % (6 patients). In 1 patient the cause of death was the hemorrhagic shock in 4 — progressive liver failure. After surgery, the patient 1 Sugiura died as a result of hepatorenal syndrome and multiple organ failure.
During the 1-year because of recurrent bleeding re-hospitalized patients 2, both made emergency sclerotherapy, thereby achieved hemostasis.
The effectiveness of endoscopic sclerotherapy in the main group reached 84.3 %.
Keywords: portal hypertension, varicose veins of esophagus, endoscopic sclerotherapy, liver failure.
Despite the increasing quality of life, continuous improvement of methods of diagnosis and treatment, the incidence of cirrhosis of the liver has no downward trend. Portal hypertension (PH) syndrome in cirrhosis leads to the development of serious, sometimes fatal complications, such as bleeding from varicose veins of the esophagus and stomach, liver failure (LF), ascitic syndrome and hepatic encephalopathy [1, 9]. Bleeding from varicose veins (VV) — one of the most difficult, dangerous and difficult to forecast complications, which
often leads to death. Patients die of acute and chronic posthemorrhagic anemia, progression of LF [8].
The introduction of new and improvement of existing minimally invasive endoscopic hemostasis opened a new page in dealing with esophageal-gastric bleeding portal genesis [6; 10]. According to various sources, the rate of achieving hemostasis at active bleeding greater than 90 % and the mortality rate is reduced to 15 % [7]. In addition, the proven efficacy of endoscopic methods in the prevention
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