Use of the Living With Heart Failure questionnaire to ascertain patients' perspectives on improvement in quality of life versus risk of drug-induced death.
Use of the Living With Heart Failure questionnaire to ascertain patients' perspectives on improvement in quality of life versus risk of drug-induced death.
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DOI：
10.1016/1071-9164(95)90025-x
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发表时间：
1995-06-01
影响因子：
6
通讯作者：
Silver, M A
中科院分区：
文献类型：
--
作者：
Rector, T S;Tschumperlin, L K;Silver, M A
心力衰竭的治疗，例如氟喹南，可能会对生存和生活质量产生相反的影响。心力衰竭生活调查问卷用于检查患者冒药物引起的死亡风险以提高生活质量的意愿。此外，还描述了患者对心力衰竭评分值得改善的意见，为解释临床试验结果提供了视角。对心脏病诊所的 101 名心力衰竭患者进行了访谈。心力衰竭患者问卷评分中位数（四分位距）为 54（四分位距，34-74）。如果心力衰竭生活评分的相应改善为 20（四分位数范围，10-25），则 49% 的患者会接受药物引起的死亡风险为 100 分之一。相比之下，40% 的人愿意接受药物引起的死亡风险等于或大于 100 分之 5 的情况，因为评分显着提高 (P < .001) 为 5 分（四分位数间距，5-10）。在接受药物引起的死亡风险较高的亚组中，随心力衰竭继发的感知限制而增加的心力衰竭生活评分往往较高，但不显着 (P = .22)：45（四分位距，34-73）与 58（四分位距，42-77）。临床试验中常见的评分改善为 5 分，这足以让 72% 的患者服用没有副作用或显着费用的药物。当成本或风险与治疗相关时，5 点的改善不太可接受：52% 的人愿意每月支付 60 美元，38% 的人愿意冒药物引起的死亡风险。这些数据表明，许多心力衰竭患者愿意接受一定程度的药物引起的死亡风险，以提高生活质量。根据成本和不良反应，心力衰竭生活评分提高 5 分可能具有临床意义。心力衰竭生活问卷可用于帮助患者评估医疗干预的获益与风险。
Treatments for heart failure, such as flosequinan, may have opposite effects on survival and quality of life. The Living With Heart Failure questionnaire was used to examine patients' willingness to risk drug-induced death for improved quality of life. In addition, patients' opinions concerning worthwhile improvements in the Living With Heart Failure score were described to provide a perspective for interpreting the results of clinical trials. A sample of 101 patients with heart failure were interviewed in cardiology clinics. Median (interquartile range) Living With Heart Failure questionnaire score were 54 (interquartile range, 34-74). Forty-nine percent of the patients would accept a1 in 100 risk of drug-induced death if the corresponding improvements in the Living With Heart Failure score were 20 (interquartile range, 10-25). In contrast, 40% were willing to accept a risk of drug-induced death equal to or greater than 5 in 100 for significantly (P < .001) smaller score improvements of 5 (interquartile range, 5-10). Living With Heart Failure scores that increase with perceived limitations secondary to heart failure tended to be higher, although not significantly (P = .22), in the subgroup that accepted greater risk of drug-induced death: 45 (interquartile range, 34-73) versus 58 (interquartile range, 42-77). A score improvement of 5, which has been commonly observed in clinical trials, would be sufficient reason for 72% of patients to take a medication that did not have side effects or significant costs. A 5-point improvement was less acceptable when costs or risks were associated with therapy: 52% would pay $60 per month and 38% would risk drug-induced death. These data suggest that many patients with heart failure would accept some risk of drug-induced death for improved quality of life. A 5-point improvement in the Living With Heart Failure score may be clinically significant depending on costs and adverse effects. The Living With Heart Failure questionnaire can be used to help patients evaluate the benefits versus risks of medical interventions.