Impact of drug therapy on long-term prognosis in patients with ischemic chronic heart failure with preserved ejection fraction and renal dysfunction

Improvement of the treatment of cardiovascular disease has led to an increase number of patients with chronic heart failure with preserved ejection fraction (HFpEF), but at the moment there is no differentiated approach based on the principles of evidence-based medicine.Aim. To investigate the effect of modern combined drug therapy for long-term prognosis in patients with ischemic HFpEF and renal dysfunction.Materials and methods. The study involved 243 patients (80.3% men) with ischemic HFpEF with renal dysfunction (age 58.7±9.3 years). Therapy included: ACE inhibitors/ARBs (98.3 %), statins (95.9 %), antiplatelet agents (94.2 %), beta blockers (91.3 %), diuretics (53.5 %), trimetazidine (30.9 %), calcium antagonists (26.3 %), mineralocorticoid receptor antagonists (16.5 %), amiodarone (11.9 %). The follow-up period was 3 years. The cumulative survival curves were constructed by the Kaplan-Meier method using and groups were compared with the log-rank test.Results. It was found that the torasemide inclusion in the therapy of patients with ischemic HFpEF and renal dysfunction in comparison with furosemide was accompanied by a reduction in adverse cardiovascular events (hazard ratio (HR) 4.92; 95% CI 1.47-16.4; p=0.009), ARB has a positive effect (HR 0.46; 95% CI 0.21-1.07; p=0.07), and the inclusion of amiodarone was accompanied by an increase number of adverse events (HR 3.27; 95% CI 1.38-7.74, p=0.006). Beta-blockers reduced the risk of sudden cardiac death (HR 0.09; 95% CI 0.01-0.58, p=0.01). It was found that amiodarone (HR 4.69; 95% CI 1.26-17.3; p=0.02) and AMR (HR 4.81; 95% CI 1.62-14.3; p=0.004) increased the risk of hospitalization.Conclusion. As a result of a three-year follow-up of patients with ischemic HFpEF and renal dysfunction it was found that among diuretics torasemide has preference over furosemide in respect of the impact on cumulative endpoint. Beta-blockers were effective in preventing sudden cardiac death, and angiotensin II receptor blockers reduced the risk of atherothrombotic events.