Quality of life and adherence to treatment in patients with heart failure during extreme temperatures (heat) in Vinnitsia region

Abstract

Abstract. Many studies demonstrate the negative impact of various weather conditions on the human body. This also applies to high temperatures, which can cause increased synthesis of interleukins, fluctuations in blood pressure, increased manifestations of coronary heart disease, edema, electrolyte disturbances, and an increase in the frequency of treatment side effects. However, there are insufficient data to indicate changes in the quality of life of patients with heart failure (HF) under the influence of high temperatures and changes in treatment adherence in such patients with optimally selected therapy to high temperatures. The aim was to assess the impact of heat on the quality of life and adherence to treatment in patients with heart failure. Materials and methods. We examined 44 patients (mean age 64.25±0.26 years) with stage C HF with a slightly reduced ejection fraction ranging from 40-50%, who had an average but not less than 7 points and high adherence to treatment before the study. The treatment of HF and other comorbidities in patients was performed according to the protocols and patients were in the phase of clinical compensation on the background of optimally selected pharmacological treatment at the time of the study. All emergencies a ssociated with blood pressure fluctuations and coronary symptoms occurred in patients who smoked, which amounted to 27.3%. Patients who smoked but were not hospitalized during the observation period accounted for 13.64%, which was not significant. No significant blood glucose fluctuations were noted in the patients included in the study. Results and discussion. When assessing quality of life indicators, they significantly deteriorated: from 14.68±0.22 points before the study to 33.45±0.75 (p<0.001) after the study. The most pronounced changes were observed in obese patients, especially due to edema syndrome, blood pressure fluctuations, and it is important that patients with different degrees of obesity were more prone to depression. An important component of the deterioration in the quality of life was a violation of adequate sleep, which was manifested in 100% of patients, impaired concentration, increased treatment costs, increased difficulty walking, increased fatigue, increased heart rate, shortness of breath. In 42 (90.9%) patients, treatment required changes. The number of hospitalizations or ambulance calls increased. The following data were obtained: after a week of exposure to high temperatures, treatment adherence decreased from 100% of patients to 18.2% (p<0.001) who had 7 or more points on the adherence questionnaire, and after two weeks there was not a single patient who had satisfactory adherence. Conclusions. In view climate change, which is a serious problem for the entire humanity, it is important to note that the health status of patients with HF, even with optimally selected treatment, remains important, which contributes to a deterioration in the quality of life of such patients and a marked decrease in adherence to treatment, increased costs of treatment, treatment regimens, as well as the occurrence of impaired concentration, a tendency to depression, which requires additional control examinations, correction of treatment regimens and the prescription of additional drugs. Reduced adherence to treatment significantly increases the incidence of morbidity and complications, which in turn increases disability and mortality, even in a short period of time. It is also important that the duration of weather anomalies has a negative impact on treatment adherence. It has been noted nthat complications of various diseases are more common in smokers, and adherence to treatment is lower in obese patients, although these data need to be clarified in a larger cohort of patients. In accordance with the identified changes, it is recommended to draw up a treatment plan more carefully, to communicate with the patient in case of a violation of the general condition and to correct the identified changes more quickly, to develop a strategy for correcting the patients' condition, taking into account the manifestations of the underlying disease and the development of comorbid conditions, such as sleep disturbance, impaired attention, and the development of depression. It is the professional timely correction of the detected symptoms that will mitigate the impact of abnormal temperatures and preserve public health.