Relationship Between Self-care and Health-Related Quality of Life in Older Adults With Moderate to Advanced Heart Failure
Relationship Between Self-care and Health-Related Quality of Life in Older Adults With Moderate to Advanced Heart Failure
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DOI：
10.1097/jcn.0b013e3182106299
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发表时间：
2012-01-01
影响因子：
2
通讯作者：
Riegel, Barbara
中科院分区：
文献类型：
--
作者：
Buck, Harleah G.;Lee, Christopher S.;Riegel, Barbara
背景：遵循治疗方案并在症状升级之前关注症状的心力衰竭（HF）患者被认为比自我保健能力差的患者具有更好的健康相关生活质量（HRQOL），但几乎没有数据支持或反驳这一假设。目的：本研究的目的是描述患有中度至晚期心力衰竭的老年人（≥ 65 岁）的心力衰竭自我护理与 HRQOL 之间的关系。方法：使用心力衰竭自我护理指数的 3 个量表（维持、管理和信心）来衡量自我护理。分数范围从 0 到 100，数字越高表示自我保健能力越好。与健康相关的生活质量通过明尼苏达心力衰竭生活问卷进行测量，这是一种 2 分量表（身体和情感）工具。明尼苏达心力衰竭生活问卷中的数字越低表明 HRQOL 越好。分析中使用了 Pearson 相关性、独立样本 t 检验以及线性和逻辑回归模型。结果：在 207 名纽约心脏协会 III 级 (82%) 或 IV 级成人（72.9 [SD，6.3] 岁）中，观察到自我保健信心与总信心 (r = -0.211；P = .002)、身体信心 (r = -0.189；P = .006) 和情绪 HRQOL (r = -0.201；P = .004) 之间存在显着的线性关联。与报告 HRQOL 得分高于中位数的患者相比，报告较好（低于中位数）HRQOL 的患者的置信度得分更高（58.8 [19.2] vs 52.8 [19.6]；P = .028）。信心是总 HRQOL（β s = -3.191；P = .002）、身体 HRQOL（β s = -2.346；P = .002）和情绪 HRQOL（β s = -3.182；P = .002）的独立决定因素，控制其他心力衰竭自我护理指数评分、年龄、性别和纽约心脏协会等级。置信度每增加 1 点，患者在相同对照下的 HRQOL 评分（比值比，0.980 [95% 置信区间，0.963-0.998]）较差（高于中位数）的可能性就会降低。自我保健维护或管理与 HRQOL 之间没有发现显着关联。结论：个体对心力衰竭自我护理的信心程度与 HRQOL 相关，但具体维护和管理行为的自我报告则无关。提高自我护理信心的干预措施对于中度至晚期心力衰竭的老年人可能尤其重要。
Background: Heart failure (HF) patients who follow the treatment regimen and attend to symptoms before they escalate are assumed to have better health-related quality of life (HRQOL) than those with poor self-care, but there are few data available to support or refute this assumption. Objective: The objective of the study was to describe the relationship between HF self-care and HRQOL in older (>= 65 years old) adults with moderate to advanced HF. Methods: Self-care was measured using the 3 scales (maintenance, management, and confidence) of the Self-care of Heart Failure Index. Scores range from 0 to 100, with higher numbers indicating better self-care. Health-related quality of life was measured with the Minnesota Living With Heart Failure Questionnaire, a 2-subscale (physical and emotional) instrument. Lower numbers on the Minnesota Living With Heart Failure Questionnaire indicate better HRQOL. Pearson correlations, independent-samples t-tests, and linear and logistic regression modeling were used in the analysis. Results: In 207 adults (72.9 [SD, 6.3] years), New York Heart Association class III (82%) or IV, significant linear associations were observed between self-care confidence and total (r = -0.211; P = .002), physical (r = -0.189; P = .006), and emotional HRQOL (r = -0.201; P = .004). Patients reporting better (below median) HRQOL had higher confidence scores compared with patients reporting above-median HRQOL scores (58.8 [19.2] vs 52.8 [19.6]; P = .028). Confidence was an independent determinant of total (beta s = -3.191; P = .002), physical (beta s = -2.346; P = .002), and emotional (beta s = -3.182; P = .002) HRQOL controlling for other Self-care of Heart Failure Index scores, age, gender, and New York Heart Association class. Each 1-point increase in confidence was associated with a decrease in the likelihood that patients had worse (above median) HRQOL scores (odds ratio, 0.980 [95% confidence interval, 0.963-0.998]) with the same controls. No significant associations were found between self-care maintenance or management and HRQOL. Conclusions: The degree of individual confidence in HF self-care is related to HRQOL, but self-reports of specific maintenance and management behaviors are not. Interventions that improve self-care confidence may be particularly important in older adults with moderate to advanced HF.