Comparative analysis of data from the outpatient electronic medical records of patients of different ages with chronic heart failure: results and problems

DOI: https://doi.org/10.29296/25877305-2022-12-06
Issue: 
12
Year: 
2022

Chernyavskaya T., Kakorina E., Samorodskaya I.

Objective. To determine clinical features and management tactics in patients with chronic heart failure (CHF) in three age groups, by analyzing their electronic medical records (EMRs). Material and methods. EHRs were analyzed in 683 patients from healthcare facilities in the urban districts of the Moscow Region who sought medical assistance in 2021, in whom ICD-10 Code I50 (heart failure) was indicated as one of the diagnosis codes (for complications). For analysis, three groups were formed: 18–59 year-olds; 60–70 year-olds; and over 71-year-olds. Results. Statistically significant differences were found in the frequency of recording hypertension (85, 90, and 94%, respectively), cardiomyopathy (5.6, 0.8, and 0.4%), prior COVID-19 infection (78, 26, and 17%), and in the rate of hospitalization for any cause (52, 43, and 63%). At the same time, there were no differences in hospitalization rates for diagnosed COVID-19 (4.4, 4.5, and 4.6%, respectively). The proportion of women in the sample increased significantly with age (32%, 49%, and 65%). The frequency of consultations in the third-level institutions or the Federal Center was 86; 79 and 69%, respectively (p < 0.0001). There were no differences in the frequency of using different groups of drugs (22.8; 20.2 and 22.9%), including triple therapy. The discussion presents the problems of evaluating patient management tactics based on EHRs. Conclusion. The clinical and gender characteristics of patients with CHF and their management tactics differ in different age groups. However, the unstructured filling in of EHRs and a single data upload fail to fully assess the compliance of management tactics in CHF patients with clinical practice guidelines and to judge the efficiency of patient treatment.

Keywords: 
cardiology
chronic heart failure
age characteristics
diagnosis
treatment
triple therapy
COVID-19



References: 
  1. McDonagh T.A., Metra M., Adamo M. et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42: 3599–726. DOI: 10.1093/eurheartj/ehab368
  2. 2020 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2020; 25 (11): 4083 (in Russ.). DOI: 10.15829/1560-4071-2020-4083
  3. Boytsov S.A. Chronic heart failure: evolution of etiology, prevalence and mortality over the past 20 years. Ter Arkh. 2022; 94 (1): 5–8 (in Russ.). DOI: 10.26442/00403660.2022.01.201317
  4. 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee». J Am Coll Cardiol. 2021; 77 (6): 772–810. DOI: 10.1016/j.jacc.2020.11.022
  5. Samorodskaya I. Problems in choosing treatment options. Vrach. 2020; 31 (8): 11–8. (in Russ). DOI: 10.29296/25877305-2020-08-02
  6. Aerts H., Kalra D., Sáez C. et al. Quality of Hospital Electronic Health Record (EHR) Data Based on the International Consortium for Health Outcomes Measurement (ICHOM) in Heart Failure: Pilot Data Quality Assessment Study. JMIR Med Inform. 2021; 9 (8): e27842. DOI: 10.2196/27842
  7. Gilyarevsky S.R., Gavrilov D.V., Gusev A.V. Retrospective analysis of electronic health records of patients with heart failure:the first Russian experience. Russian Journal of Cardiology. 2021; 26 (5): 4502 (in Russ.). DOI: 10.15829/1560-4071-2021-4502
  8. Azad N., Lemay G. Management of chronic heart failure in the older population. J Geriatr Cardiol. 2014; 11 (4): 329–37. DOI: 10.11909/j.issn.1671-5411.2014.04.008
  9. Arenas Ochoa L.F., González-Jaramillo V., Saldarriaga, C. et al. Prevalence and characteristics of patients with heart failure needing palliative care. BMC Palliat Care. 2021; 20 (1): 184. DOI: 10.1186/s12904-021-00850-y
  10. Chernyavskaya T.K., Glezer M.G. Clinical characteristics and treatment of outpatients with chronic heart failure in the Moscow Region. Almanac of Clinical Medicine. 2021; 49 (2): 125–31 (in Russ.). DOI: 10.18786/2072-0505-2021-49-023
  11. Polyakov D.S., Fomin I.V., Belenkov Yu.N. et al. Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCH-CHF study. Kardiologiia. 2021; 61 (4): 4–14 (in Russ.). DOI: 10.18087/cardio.2021.4.n1628
  12. Tromp J., Ouwerkerk W., Teng T.K. et al. Global disparities in prescription of guideline-recommended drugs for heart failure with reduced ejection fraction. Eur Heart J. 2022; 43 (23): 2224–34. DOI: 10.1093/eurheartj/ehac103
  13. Podolskaya A.A., Palmova L.Yu., Shaikhutdinova Z.A. Chronic heart failure in real clinical practice. Bulletin of modern clinical medicine. 2019; 12 (5): 45–9 (in Russ.). DOI: 10.20969/VSKM.2019.12(5).45-49
  14. Pogosova N.V., Isakova S.S., Sokolova O.Y. et al. Factors affecting the uptake of national practice guidelines by physicians treating common CVDS in out-patient settings. Kardiologiia. 2022; 62 (5): 33–44 (in Russ.). DOI: 10.18087/cardio.2022.5.n1945