EFFECT OF THERAPEUTIC TRAINING AND ACTIVE OUTPATIENT MANAGEMENT ON CLINICAL STATE AND CARDIOVASCULAR COMPLICATIONS IN PATIENTS WITH CHRONIC HEART FAILURE (THREE YEAR FOLLOW-UP)

Aim.  To  evaluate  effect  of  therapeutic  training  and  active  outpatient management  on  clinical  state  and  cardiovascular  complications  (CVC)  in  patients with  chronic  heart  failure  (CHF)  during  three year follow-up. Material and methods. A total of 211 patients with CHF experienced Q-wave myocardial infarction were enrolled in the study. At admission to the hospital all patients were randomized into two groups. Patients of the first group (group 1; n=106) were managed actively after discharge from the hospital, patients of the second group (group 2; n=105) - managed conventionally after discharge from the hospital. In the hospital patients of the both groups were therapeutically trained and treated according to contemporary guidelines. Patients were observed for three years.  Results. Over three year follow-up actively managed patients demonstrated significant (p<0.05) decrease in systolic and diastolic blood pressure, heart rate, blood serum levels of total cholesterol and N-terminal prohormone of brain natriuretic peptide (NT-proBNP), augmentation of 6-minute walk-test distance, deceleration of heart remodeling and left ventricle ejection fraction reduction as compared to those who were conventionally managed. Kaplan-Meier curves revealed that risk of CHF decompensation (р=0.001), mortality (р=0.04), and total number of CVC (р=0.04) was significantly lower in the first group than this in the second one. Conclusion. Therapeutic training and active outpatient management in patients with CHF improves patient compliance to pharmacotherapy , their clinical state and outcomes.

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