FEATURES OF THE CLINICAL COURSE OF STABLE ISCHEMIC HEART DISEASE IN COMBINATION WITH COMMUNITY-ACQUIRED PNEUMONIA IN ELDERLY PATIENTS, IN THE FOCUS OF STATINS

Abstract

Despite modern advances in cardiology, stable ischemic heart disease remains the most urgent medical and social problem, which is caused by a high level of morbidity and mortality.

The aim of the study – to determine the clinical course, functional and structural restructuring of the left heart departments in patients with stable ischemic heart disease in combination with community-acquired pneumonia and the effectiveness of treatment with additional inclusion in the complex traditional treatment of rosuvastatin in a daily dose of 40 mg in the evening, for the entire period of treatment in the hospital and, further, on an outpatient basis for 6 months.

Material and Methods. The study included 77 patients over the age of 65 years. The patients were divided into 3 groups: the group 1 included patients with stable ischemic heart disease with concomitant community-acquired pneumonia (n = 32), the group 2 – patients with isolated community-acquired pneumonia (n=27), the group 3 – 18 patients with isolated stable ischemic heart disease who were treated in the therapeutic Department of the Hospital of Communard district, Zaporizhzhia during 2017. The average age of patients was (66.2±7.1) years. There were 42 men and 35 women. All patients had a general-clinical examination according to domestic recommendations. Additionally, patients had echocardiography in M- and B-modes. Diagnosis of stable ischemic heart disease was established on the basis of the order of the Ministry of Health of Ukraine No. 152 dated 02.03.2016. Diagnosis of emergency situations – according to the order of the Ministry of Health of Ukraine (No. 128 dated March 19, 2007). Patients with stable ischemic heart disease as a combined course (stable ischemic heart disease + community-acquired pneumonia) and with isolated stable ischemic heart disease received treatment in accordance with the "Protocol providing medical care to patients with ischemic heart disease: stable angina tension" (Order of the Ministry of Health of Ukraine No. 152 dated 02.03.2016), patients on the state of emergency – according to the “Protocol on the provision of medical care to patients with infectious diseases of adult persons” (Order of Ukraine No. 128 dated March 19, 2007).

Prior to hospitalization, all patients with stable ischemic heart disease received, according to the protocol, statins (rosuvastatin) in a dose of 10–20 mg. Taking into account the pleiotropic anti-inflammatory action of statins and their ability to improve the function of external respiration, due to the growth of FEV, forced lung capacity, patients in group 1, against the appointment of traditional therapy community-acquired pneumonia and stable ischemic heart disease, we prescribed rosuvastatin daily dose 40 mg 1 time day by night. Patients in group 2, the dose of statins that patients had taken earlier, did not change.

Results. According to objective, laboratory and instrumental data, it was established that the community-acquired pneumonia contributes to the worsening of the clinical course of stable ischemic heart disease: the heart rate and the frequency of respiratory movements were significantly higher by 23.4 % (p<0.05) – by 10.1 % (p<0.05), reduction of oxygen saturation by 2.7 % (p<0.05), increase in ESR indices by 13.7 %, leukocytosis – by 26.0 %, and indicators of immune activating activation – СRP – on 9.6 % (p<0.05) in comparison with patients of the group 2 (stable ischemic heart disease without community-acquired pneumonia). The function of external respiration in patients of the group 1 was slightly violated basically – by the restrictive type. Patients in group 1 who were additionally assigned rosuvastatin in a daily dose of 40 mg, after 10–12 days, positive dynamics was observed: improvement of the general condition and blood parameters. Also, the period of stay of these patients in the hospital was (14.2±1.1) days versus (16.62±1.0) (p<0.05) in patients with isolated stable ischemic heart disease who received only traditional treatment. The effect of the intended comprehensive treatment on the prognosis of stable ischemic heart disease, after a postponed community-acquired pneumonia, was studied by a family doctor outpatient for 6 months later.

Conclusions. Analysis of the results of the study: the general condition of patients in both groups, the indicators of laboratory and instrumental studies, indicate the negative impact of community-acquired pneumonia on the flow of stable ischemic heart diseases in patients of the elderly, in contrast to patients with isolated stable ischemic heart disease. Comprehensive protocol treatment for patients with comorbid flow of SIC stable ischemic heart diseases with concomitant community-acquired pneumonia with an additional appointment of the drug rosuvastatin (40 mg per night per night) during inpatient treatment – promotes faster recovery of patients with community-acquired pneumonia. Continuation of the same taking rosuvastatin patients with stable ischemic heart disease after the transferred community-acquired pneumonia for another six months, at the same dose, indicates its positive effect on the state of cardioghemodynamics, and causes a more favorable course of the disease and improve the quality of life of patients, as evidenced by the absence of repeated hospitalizations among 32 patients with stable ischemic heart disease who have undergone community-acquired pneumonia, during the entire period of observation.