RU2843471C1 - Method for predicting the edmonton (esas) severe symptoms dynamics in a patient with chronic heart failure and sarcopenic obesity at the stage of palliative care - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention refers to medicine, namely to therapy and cardiology, and can be used for the Edmonton scale (ESAS) progression prediction in a patient suffering chronic heart failure and sarcopenic obesity at the stage of palliative care. If the result according to the questionnaire for the diagnosis of sarcopenia (SARC-F) is less than 6 points, or if the galectin-3 level is less than 29 ng/ml, or if the level of highly sensitive C-reactive protein (hsCRP) is less than 4.76 mg/l, stable minimum dynamics of severe symptoms, expressed in 4 or less Edmonton scores, is predicted. If any of the three examined values is higher than the above, an increasing dynamic of severe symptoms expressed in more than 4 Edmonton points is predicted.

EFFECT: method provides the most accurate and timely detection of the patients in need of the correction of the severity of the severe symptoms by determining SARC-F score, galectin-3 and hsCRP levels.

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Description

The invention relates to medicine, namely to therapy and cardiology, and can be used to predict the severity of distressing symptoms in patients with chronic heart failure (CHF) and sarcopenic obesity at the stage of providing palliative medical care.

The prevalence of chronic heart failure (CHF) in the Russian Federation is currently about 7% [Boitsov S.A. Chronic heart failure: evolution of etiology, prevalence and mortality over the past 20 years. Therapeutic archive. 2022; 94 (1): 5-8]. It is known that survival in CHF is often worse than in oncological diseases [Vinogradova N.G., Polyakov D.S., Fomin I.V. Analysis of mortality in patients with CHF after decompensation during long-term observation in specialized medical care and in real clinical practice. Cardiology. 2020; 60 (4): 91-100].

It is important to note that patients with CHF represent a fairly large pool of candidates for palliative medical care (PMC), and the severity of distressing symptoms affects the quality of life of such patients and requires correction of medical interventions.

To date, there are virtually no studies that would be devoted to the issue of the structure and severity of distressing symptoms in patients with CHF, as well as predicting the course of the disease at the stage of providing primary medical care, which determines the need to search for methods for predicting the palliative status of patients with CHF.

The "Method for predicting the risk of developing an unfavorable clinical course of heart failure with preserved left ventricular ejection fraction within 12 months" is known [RU Patent No. 2826921 dated September 18, 2024]. The authors determine carbohydrate metabolism disorders, adherence to treatment according to the Morisky-Green scale, the concentration of growth differentiation factor 15 in the blood serum and the duration of hypertension in the anamnesis. After that, using the specified formula, the risk of developing an unfavorable course of CHF with preserved left ventricular ejection fraction within 12 months is calculated. The method ensures timely identification of patients in the high-risk group for an unfavorable course of the disease.

The disadvantages of the method are that it predicts the course of the disease not for all patients with CHF, but only for those with preserved ejection fraction, as well as for patients with comorbid diabetes mellitus, does not take into account changes in body composition and does not reflect palliative status.

A method for predicting the course of chronic heart failure is known [Russian Federation application No. 2011152726 dated 27.06.2013], which consists in the fact that the authors, by means of a clinical and laboratory examination with the determination of the polymorphic locus C-344T of the aldosterone synthase gene, and in the case of the presence of the T allele and the T/T, C/T genotypes in the patient, predict a high individual risk of an unfavorable course of chronic heart failure, in the presence of the C allele and the C/C genotype in the patient, predict a favorable course of chronic heart failure.

The disadvantage of this method is that it predicts the course of CHF, but not the palliative status.

A method for predicting the course of chronic heart failure in patients with ischemic heart disease is known [RU Patent No. 2545899 dated 10.04.2015]. The authors determine the polymorphism of the gene of the protein p53. In the presence of the Arg allele and the Arg/Arg genotype of the polymorphic locus Arg72Pro of exon 4, an unfavorable course of the disease is predicted. The invention ensures effective prediction of the unfavorable course of chronic heart failure in patients with ischemic heart disease, which makes it possible to identify a priority group of patients for dispensary observation with the organization of measures aimed at preventing premature mortality in them.

The disadvantages of the method are that it is used only in patients with coronary heart disease and the impossibility of predicting the severity of distressing symptoms at the stage of providing palliative medical care.

Our clinical observations revealed the influence of patient body composition indicators (BMI, BMI/BMI) and markers galectin-3, high-sensitivity C-reactive protein (hsCRP) on the severity of distressing symptoms at the stage of providing palliative medical care.

It is known that the patient's body composition affects the course and prognosis of the disease [Drapkina O.M., Skripnikova I.A., Yaralieva E.K., Myasnikov R.P. Body composition in patients with chronic heart failure. Cardiovascular Therapy and Prevention. 2022; 21 (12): 226-233]. The presence of sarcopenia and obesity are factors aggravating the disease [Soto M.E., Perez-Torres I., Rubio-Ruiz M.E., Manzano-Pech L., Guarner-Lans V. Interconnection between Cardiac Cachexia and Heart Failure-Protective Role of Cardiac Obesity. Cells. 2022; 11 (6) 1039; Ohori K., Yano T., Katano S. et al. High percent body fat mass predicts lower risk of cardiac events in patients with heart failure: an explanation of the obesity paradox. BMC Geriatrics. 2021; 21 (1): 16].

The prognostic potential of galectin-3 in CHF was studied [Naureen A., Munir K., Hammad A.R., Khan M.S., Mengal M., Mengal M.A. Correlation of Serum Galectin-3 Levels with Ejection Fractions in Healthy Subjects and Heart Failure Patients. Pakistan Journal of Medical and Health Sciences. 2023; 17 (2): 689-691]. hsCRP is a known marker of systemic inflammation, and its blood level correlates with the severity and outcomes of CHF and COC [Pacifico J., Geerlings M.A.J., Reijnierse E.M. et al. Prevalence of sarcopenia as a comorbid disease: A systematic review and meta-analysis. Exp Gerontol. 2020; 131: 110801].

The technical result of the method we have developed is to increase the functional activity and quality of life of patients.

The technical result is achieved as follows.

The developed method is based on the results of clinical observation and examination of 298 patients diagnosed with chronic heart failure, including 72 with sarcopenic obesity, 45 with weight loss combined with sarcopenia, 79 patients with sarcopenia, 49 without fat and muscle mass disorders, 53 patients with obesity without sarcopenia. The average age of patients is 61 (53÷69) years. The diagnosis of "Chronic heart failure" is made on the basis of verified standardized validated criteria and clinical and functional methods regulated by the clinical guidelines of the Ministry of Health of the Russian Federation.

In order to assess body composition, all patients were administered the SARC-F questionnaire [https://cr.minzdrav.gov.ru/scale/4eebe349-e90d-447c-b079-alb02db3d34c, accessed 10/29/2023], wrist dynamometry, bioimpedancemetry, and the 4 m walking speed test. The diagnostic criterion for sarcopenic obesity was the data provided by the National Institute of Nutrition Foundation: BMI/BMI for men less than 0.789, for women less than 0.512; muscle strength for men less than 26 kg, for women less than 16 kg.

Galectin-3 and hsCRP markers were assessed. The severity of distressing symptoms was assessed using the Edmonton Anxiety Disorders Scale (ESAS) [https://pubmed.ncbi.nlm.nih.gov/33252169/ accessed 10/29/2023], functional activity was determined using the Barthel index [https://sudact.ru/law/klinicheskie-rekomendatsii-starcheskaia-asteniia-utv-minzdravom-rossii/prilozhenie-g/prilozhenie-g11/ accessed 10/29/2023], and quality of life was determined using the Minnesota Questionnaire for Quality of Life in Patients with CHF [https://textarchive.ru/c-1657571-р14.html accessed 10/29/2023].

During clinical observations, depending on the severity of distressing symptoms, patients with sarcopenic obesity were divided into 2 groups, namely:

Group 1 - patients with minimal severity of symptom dynamics (4 or less points on the Edmonton scale).

Group 2 - patients with pronounced dynamics of distressing symptoms (more than 4 points on the Edmonton scale), while the symptoms require medical correction.

We conducted dynamic observation of patients and found that the severity of symptoms was minimal and remained at a level of 4 or less points on the Edmonton scale in patients with a galectin-3 marker level of less than 29 ng/ml or a hsCRP marker level of less than 4.76 mg/l or a SARC-F questionnaire result of less than 6. In those patients whose indicators were higher than the threshold values established during the study, the distressing symptoms progressively worsened, and Edmonton scale values of more than 4 points were recorded.

During quarterly dynamic observation with assessment of the severity of distressing symptoms according to the Edmonton scale, it was revealed that patients of the first group, in the absence of dynamics of parameters in relation to the established threshold values, had stable dynamics of the severity of distressing symptoms over 4 years of observation. In patients of the second group, on the contrary, the severity of symptoms progressed.

The quality of the forecasting results is shown in Table 1.

Clinical example 1

Patient A., 74 years old, diagnosed with CHF. FC 3. Palliative status assigned. BMI/BMI 0.65, BMI 31 kg/ ^m2 , SHOCK 7 points, hsCRP level 3.5 mg/l. Barthel index 65, quality of life according to the Minnesota questionnaire 58 points.

It has been clinically established that the patient suffers from sarcopenic obesity and belongs to group 1. Mild distressing symptoms are predicted.

During dynamic observation one year after establishing palliative status, the patient assessed the severity of fatigue and dyspnea as 2 points. The patient was prescribed a rehabilitation program, after which the patient improved her BMI/BMI to 0.9, the Barthel index was 80 points. The patient is more functionally active, fatigue has decreased. The patient's quality of life has improved (58 points according to the Minnesota Quality of Life Questionnaire in Patients with CHF before rehabilitation; 45 - after). The severity of symptoms according to the Edmonton scale is 1.

In this case, using our system, a correct prognosis was obtained, and the use of the rehabilitation program led to an improvement in functional activity and quality of life.

Clinical example 2

Patient V., 69 years old, diagnosed with CHF. FC 4. Palliative status assigned, concerns about fatigue, shortness of breath, anxiety, appetite disturbance. BMI 30.5 kg/ ^m2 , BMI/BMI 0.65, SHOCK 15, SARC-F 8 points. Barthel index 35, quality of life according to the Minnesota questionnaire 80 points.

It has been clinically established that the patient suffers from sarcopenic obesity and belongs to group 2. Expressed distressing symptoms are predicted.

During dynamic observation six months after establishing palliative status, the patient rated the severity of fatigue and shortness of breath, appetite disorders as 7 points. The patient's drug therapy was changed, aimed at reducing the severity of symptoms, and a rehabilitation program was prescribed, after which the patient improved his BMI/BMI to 0.8, the Barthel index was 65 points. The patient is more functionally active, fatigue has decreased. The patient's quality of life has improved (58 points according to the Minnesota Quality of Life Questionnaire in Patients with CHF before rehabilitation; 45 - after). The severity of symptoms according to the Edmonton scale is 2.

In this case, using our system, a correct prognosis was obtained, and correction of treatment measures led to a decrease in the severity of distressing symptoms, an improvement in functional activity and quality of life.

Claims (1)

A method for predicting the dynamics of burdensome symptoms according to the Edmonton scale (ESAS) in a patient with chronic heart failure and sarcopenic obesity at the stage of providing palliative medical care, including determining the scores according to the questionnaire for the diagnosis of sarcopenia (SARC-F), the level of galectin-3 and the level of high-sensitivity C-reactive protein (hsCRP), and if the result according to the SARC-F questionnaire is less than 6 points, or if the level of galectin-3 is less than 29 ng/ml, or if the level of hsCRP is less than 4.76 mg/l, a stable minimal dynamics of burdensome symptoms is predicted, expressed in 4 or less points according to the Edmonton scale; if the values of any of the three studied indicators are higher than those indicated, an increase in the dynamics of burdensome symptoms is predicted, expressed in more than 4 points according to the Edmonton scale.