OBJECTIVE

To study the real clinical practice of outpatient management of patients with chronic heart failure (CHF) in the Moscow region.

MATERIAL AND METHODS

We analyzed 683 electronic medical records of patients from hospitals of urban districts of the Moscow Region who applied for medical care in 2021. All of them had heart failure code I50 as one of the diagnoses (complications). The following drugs for CHF therapy were selected for analysis: angiotensin-converting enzyme inhibitors, sartans, valsartan/sacubitril, beta-blockers, diuretics, anticoagulants, aspirin, digoxin, statins, nitrates.

RESULTS

Mean age of patients was 65.36±10.6 years; 93.7% of patients are observed in the CHF rooms of outpatient hospitals in the Moscow Region (mean follow-up period for CHF was 7.14±8.3 years). Combination of hypertension and coronary artery disease was registered in 494 patients (72.3%). Left ventricular ejection fraction (LVEF) was registered in 436 patients. Mean LVEF was 52.3±14.6%, 10.1% of patients had LVEF < 40%. Among patients with low LVEF, cardiomyopathy (11.6%) was registered significantly more often compared to those with LVEF > 40% (1.4%). Fourteen (2%) patients were hospitalized 2 times in the last 2 years, other 669 (98%) patients were hospitalized once. The majority of patients (57.1%) received 4-5 drugs. Mean number of drugs per a patient was 4.35±1.32. Combination of 3 groups of drugs (beta-blocker + ICE/sartan/valsartan/sacubitril + spironolactone) was administered in 149 (21.8%) patients; two drugs — in 332 (48.6%) ones, one drug — in 188 (27.5%) patients. Fourteen (2%) patients did not receive any drug. There were no significant differences (p=0.7) in LVEF between these groups. Physicians in the CHF rooms prescribed nitrates less often (2.5%) than therapists (16.4%) (p<0.0001). There were no other differences.

CONCLUSION

Significant discrepancies between clinical recommendations and actual clinical practice were revealed that should be interpreted as a defect of medical care in CHF patients.