[Influence of therapy schedule on hospitalization frequency and prognosis in heart failure in 3 yrs. observations].

Patients with severe systolic heart left ventricle dysfunction determine a group loaded by high mortality. Continuous search for prognostic factors as well as treatment methods influencing a prognosis coming from clinical effects of applied prescriptions and survival in the mentioned group of patients can be observed in many published reports. In the presented work a retrospective analysis has been performed with regard to 106 patients with severe heart lesion: 72 cases with ischaemic disease, 20 cases with post-inflammation heart lesion, 7 cases with hypertension and 7 cases with idiopathic congestive cardiomyopathy. The main criterion including particular patient into the group under analysis was less or equal to 30% ejection fraction confirmed by echocardiographical examination and generally understand heart insufficiency in the clinical examination and laboratory tests. The observation period concerning patients qualified to the analyzed group incorporated 36 +/- 16.5 months. Influence of the parameters obtained from clinical, electrocardiographical, Holter monitoring, chest X-Ray, and serum concentration of both sodium (Na) and potassium (K) have been analyzed. Also the survival analysis has been performed for patients treated: according standard procedures, with addition of beta-adrenolytic drug, with addition of amiodaron, with addition of combination of both beta-adrenolytic drug and amiodaron. During the observation 64 patients have died (60%), 4 patients have had heart transplantation (Htx) performed (4%) and 38 patients survived without necessity of Htx (36%). Among investigated parameters there were following ones which proved their statistical significance in terms of prognosis evaluation: ejection fraction, features of pulmonary haemostasis, HR (heart rate), SBP (systolic blood pressure), serum concentration of both sodium (Na) and potassium (K). Much better therapy effects as well as longer survival have concerned patients with hypertension disease confirmed during the anamnesis. Comparison of the survival curves referring to the patients treated according to different schemes a positive trend in the direction of survival improvement has been observed. This trend however appeared in the group treated additionally with beta-blocker and only in the outpatient follow-up. On the other hand a combination of both beta-blocker and amiodaron has been connected with improved both early and outpatient follow-up survival. The survival curves for patients treated with amiodaron only has been quite similar as in the case of patients treated according standard procedures. Addition of beta-adrenolytic drug or amiodaron or eventually both of these medicines has a significant influence into decrease of repeated hospitalizations in the group under investigation.