V.M. GAZIZYANOVA, O.V. BULASHOVA

Kazan State Medical University, Kazan

Contact details:

Bulashova O.V. — MD, Professor of the Department of Propedeutics of Internal Diseases named after Prof. S.S. Zimnitsky

Address: 49 Butlerov St., Kazan, Russian Federation, 420012, tel.: +7 (843) 296-14-03, e-mail: boulashova@yandex.ru

ORCID 0000-0002-7228-5848

In recent decades, the leading trend in the development of modern society is the aging of the population, as well as an increase in the proportion of elderly and senile people. Aging has a significant impact on the clinical characteristics, course and prognosis of diseases, changes the management tactics and treatment standards. As a rule, these patients are highly comorbid, which must be taken into account in terms of pharmacotherapy of the underlying and competing diseases.

The purpose was to study the clinical characteristics of elderly and senile patients with chronic heart failure (CHF) in association with chronic obstructive pulmonary disease (COPD).

Material and methods. The study included 104 patients with CHF, mainly of ischemic etiology, in combination with COPD, who were divided into 3 groups: 1 — younger than 60 years old, 2 — 60–79 years old, 3 — over 80 years old. To verify the clinical condition, the following studies were carried out: a 6-minute walk test, an assessment on the clinical condition scale, spirometry, echocardiography (Echo-KG), and an assessment of the quality of life according to the Minnesota questionnaire.

Results. Patients older than 80 years old differed from those younger than 60 years old by high scores on assessment scale (p = 0,038), left ventricular ejection fraction (LVEF), (p = 0,007), and low heart rate (р = 0,021). The echocardiography parameters of patients over 80 years old were characterized by low values ​​of systolic pressure in the pulmonary artery (PAP) and end diastolic size (EDS) in comparison with those under 60 years of age (p = 0,004 and p = 0,038). When studying the respiratory function, it was noted that in patients with CHF in combination with COPD, the forced expiratory volume in the first second decreases with increasing age (FEV10 and functional vital capacity of the lungs (FVC), as well as Tiffno index.

Conclusion. The study results demonstrated that the clinical profile of a patient with CHF in combination with COPD differs depending on age, which requires an integral approach to patient management tactics and stratification of the risk of adverse events.

Key words: prognosis, chronic obstructive pulmonary disease, chronic heart failure.

REFERENCES

1. Podobed I.V., Kravchenko E.S., Testova S.G. Combination of therapeutic and geriatric approaches in assessing the condition of patients with chronic heart failure. Sovremennye problemy zdravookhraneniya i meditsinskoy statistiki, 2020, no. 2, pp. 83–94 (in Russ.).
2. Oganov R.G. Vascular comorbidity: general approaches to prevention and treatment. Ratsional’naya farmakoterapiya v kardiologii, 2015, no. 11 (1), pp. 4–7 (in Russ.).
3. Osnovnye faktory riska, privodyashchie k invalidnosti v prestarelom vozraste i mery ee profilaktiki [The main risk factors leading to disability in old age and measures to prevent it]. Vsemirnaya organizatsiya zdravookhraneniya, available at: http://www.euro.who.int/_data/assets/pdf_file/0009/74709/E82970R.pdf?ua=1 (accessed on: 07.11.2017).
4. Garganeeva A.A., Okrugin S.A., Borel’ K.N. et al. Myocardial infarction at the turn of the century: demographic and social trends. Klinicheskaya meditsina, 2016, no. 94 (6), pp. 463–466 (in Russ.).
5. Robin A.P. et al. Heart failure in older patients. Br J Cardiol, 2006, vol. 13 (4), pp. 257–266.
6. Mareev V.Yu., Fomin I.V., Ageev F.T. Clinical guidelines OSSN — RKO — RNMOT. Heart failure: chronic (CHF) and acute decompensated (ADF). Diagnostics, prevention and treatment. Kardiologiya, 2018, no. 58 (S6), pp. 1–164 (in Russ.).
7. Federal’naya programma «Khronicheskie obstruktivnye bolezni legkikh», pod red. A.G. Chuchalina. 2-e izd., pererab. i dop. [Federal program «Chronic obstructive pulmonary disease», ed. A.G. Chuchalin. 2nd ed., Rev. and add.]. Moscow, 2004. P. 63.
8. Rutten F.H., Cramer M.J., Grobbee D.E. et al. Unrecognized heart failure in elderly patients with stable chronic obstructive pulmonary disease. Eur Heart J, 2005, no. 26 (18), pp. 1887–1894.
9. Mannino D.M., Buist A.S. Global burden of COPD: risk factors, prevalence, and future trends. Lancet, 2007, no. 370 (9589), rr. 765–773.
10. Anthonisen N.R., Skeans M.A., Wise R.A. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med, 2005, no. 142 (4), rr. 233–239.
11. Wright S.P., Doughty R.N., Pearl A. et al. Plasma amino-terminal pro-brain natriuretic peptide and accuracyof heart-failure diagnosis in primary care: a randomized, controlled trial. J Am Coll Cardiol, 2003, vol. 42 (10), pp. 1793–1800.
12. Oudejans I., Mosterd A., Bloemen J.A. et al. Clinical evaluation of geriatric outpatients with suspected heart failure: value of symptoms, signs, andadditional test. Eur Journal Heart Failure, 2011, vol. 13 (5), pp. 518–527.
13. Kirichenko A.A. Chronic heart failure in elderly and senile patients. Consilium medicum, 2014, no. 10, pp. 82–86 (in Russ.).
14. Vologdina I.V., Simanenkov V.I., Poroshina E.G. et al. Quality of life and adherence to therapy in elderly and senile patients with CHF, comorbid cognitive and affective impairments. Vestnik Severo-Zapadnogo gosudarstvennogo meditsinskogo universiteta im. I.I. Mechnikova, 2016, vol. 8, no. 1, pp. 45–49 (in Russ.).
15. Bharathi Upadhya, Dalane W. Kitzman Heart failure with preserved ejection fraction: New approaches to diagnosis and management. Clinical Cardiology, 2020, vol. 43, pp. 145–155.
16. Koroleva M.V., Il’nitskiy A.N., Kudashkina E.V. et al. Modern directions of pharmacotherapy and geriatric patients polymorbidity — polypharmacy — deprescribing. Sovremennye problemy zdravookhraneniya i meditsinskoy statistiki, 2019, no. 3, pp. 150–171 (in Russ.).
17. Suntsova V.A., Trofimov V.I., Suntsov D.A. et al. «Chronic polymorbid heart» and chronic heart failure in elderly patients with chronic obstructive pulmonary disease. Uspekhi sovremennoy nauki, 2017, vol. 2, no. 12, pp. 112–120 (in Russ.).
18. Gazizyanova V.M., Bulashova O.V., Khazova E.V. The study of respiratory function in patients with chronic heart failure and different ranges of ejection fraction. Kardiologiya, 2018, vol. 58 (8S), pp. 38–42 (in Russ.).
19. Chuchalin A.G., Aysanov Z.R., Chikina S.Yu. Federal’nye klinicheskie rekomendatsii po ispol’zovaniyu metoda spirometrii [Federal clinical guidelines for the use of the spirometry method], 2013.
20. Khamitov R.F., Sulbaeva K.R., Pal’mova L.Yu., Musharapova D.I. Ischemic heart disease in the context of respiratory problems. Vestnik sovremennoy klinicheskoy meditsiny, 2015, vol. 8, appl. 1, pp. 98-101 (in Russ.).