Relationships between clinical assessments and patients' perceptions of the effects of heart failure on their quality of life
Relationships between clinical assessments and patients' perceptions of the effects of heart failure on their quality of life
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DOI：
10.1016/j.cardfail.2005.10.002
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发表时间：
2006-03-01
影响因子：
6
通讯作者：
Cohn, JN
中科院分区：
文献类型：
--
作者：
Rector, TS;Anand, IS;Cohn, JN
背景：假设心力衰竭对生活质量的大部分影响可能归因于病理学产生的症状。这些概念的措施之间的关系需要进行量化，以测试这个概念model.Methods和结果：心力衰竭的病理和症状和生活质量的测量明尼苏达州生活与心力衰竭（MLHF）问卷在4个月的访问在缬沙坦心力衰竭试验进行了分析。相关和回归分析校正估计测量的可靠性被用来定量关系。通过回归模型的决定系数（100 X R-2）总结与解释变量相关的因变量的方差百分比。休息时呼吸困难、运动时呼吸困难、阵发性夜间呼吸困难、端坐呼吸、疲劳和纽约心脏协会分级与MLHF评分显著相关。综合起来，这些症状解释了MLHF评分变化的41%。控制症状，年龄解释了MLHF评分变化的4.5%，而种族，性别和现有的合并症各解释<1%。包括射血分数、B型利钠肽、颈静脉扩张、罗音、外周水肿、收缩压、肌酐和血红蛋白在内的病理学指标与症状评估没有强相关性（合并R-2 = 17%）或MLHF评分（合并R-2 = 7%）。心力衰竭的症状解释了心力衰竭对患者生活质量影响的很大一部分变化，如MLHF评分所测量的。心力衰竭对生活质量的影响可以随年龄而变化，与症状无关。心力衰竭的病理学指标，包括一些众所周知的住院和死亡风险的相关性，与症状或生活质量并不密切相关。需要进一步的研究来了解心力衰竭病理和症状之间的关系，并确定心力衰竭对患者生活质量影响的决定因素，这些因素与症状无关。
Background: Hypothetically, most of the effects of heart failure on quality of life might be attributed to symptoms produced by the pathology. Relationships between measures of these concepts need to be quantified to test this conceptual model.Methods and Results: Measurements of heart failure pathology and symptoms and quality of life as measured by the Minnesota Living with Heart Failure (MLHF) questionnaire at the 4-month visit in the Valsartan Heart Failure Trial were analyzed. Correlation and regression analyses corrected for estimated reliability of measurements were used to quantity relationships. The percentage of variance in dependent variables that was related to explanatory variables was summarized by the coefficient of determination (100 X R-2) from regression models. Dyspnea at rest, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, fatigue, and New York Heart Association class were significantly related to MLHF scores. Combined, these symptoms explained 41% of the variation in MLHF scores. Controlling for symptoms, age explained an additional 4.5% of the variation in MLHF scores, whereas race, gender, and available comorbidities each explained < 1%. Pathologic measures including ejection fraction, B-type natriuretic peptide, jugular venous distension, rales, peripheral edema, systolic blood pressure, creatinine, and hemoglobin were not strongly related to symptom assessments (combined R-2 = 17%) or MLHF scores (combined R-2 = 7%).Conclusion: Symptoms of heart failure explain a substantial proportion of the variation in the effects of heart failure on patients' quality of life as measured by the MLHF score. The effects of heart failure on quality of life can vary with age independently of symptoms. Pathologic measures of heart failure including some well-known correlates of the risk of hospitalization and death are not strongly related to symptoms or quality of life. Further Studies are needed to understand the relationships between heart failure pathology and symptoms and to identify determinants of the effects of heart failure on patients' quality of life that were not related to symptoms.