Determinants of disability in older coronary patients
Determinants of disability in older coronary patients
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DOI：
10.1067/mhj.2002.119379
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发表时间：
2002-01-01
影响因子：
4.8
通讯作者：
Niggel, J
中科院分区：
文献类型：
--
作者：
Ades, PA;Savage, PD;Niggel, J
患者报告的身体功能是残疾确定的主要组成部分，也是健康相关生活质量的重要贡献者。先前的冠状动脉残疾研究显示，在跑步机上测量的运动能力和现实生活中的活动曲线之间的相关性令人惊讶地差。本研究的目的是评估医疗因素、性别、健身相关措施和心理因素作为老年冠心病患者报告的身体功能评分的决定因素的相对重要性。（71 +/- 5岁，范围65-83岁），患有慢性CHID。通过医学结局研究简表身体功能部分测量患者报告的身体功能评分（0-100分）。独立变量包括临床和人口统计学数据、平板运动试验、静息和运动超声心动图、身体成分、力量、有氧适应性和抑郁评分。结果心肌梗死患者的身体功能评分低于其他冠心病患者（68 +/- 19 vs 82 +/- 22，P <0.05）。患者报告的身体功能评分的单变量预测因子包括峰值有氧能力（R = 0.62）、平板运动试验持续时间（R = 0.61）、抑郁评分（R = -0.60）、握力（R = 0.42）和合并症评分（R = -0.39）。峰值有氧能力（R-2 = 0.38）和抑郁评分（累积R-2 = 0.60）是身体功能的最佳独立预测因子。尽管年龄、诊断分布、抑郁评分和合并症评分相似，但女性的身体功能评分低于男性（64 +/- 22 vs 78 +/- 20，P <0.05）。静息左心室射血分数不是身体功能评分的预测因子。结论峰值有氧能力和抑郁评分是老年冠心病患者身体功能评分的最佳独立预测因子。这些数据集中在运动训练和治疗精神抑郁症的潜力，以预防和治疗老年冠心病患者的冠状动脉残疾。
Background Patient-reported physical function is a major component of disability determinations and an important contributor to health-related quality of life. Prior studies of coronary disability have shown a surprisingly poor correlation between real-life activity profile and exercise capacity measured on the treadmill. The goal of the current investigation was to evaluate the relative importance of medical factors, sex, fitness-related measures, and psychologic factors as determinants of patient-reported physical function score in older persons with established coronary heart disease (CHD).Methods Determinants of disability were studied in 51 community-dwelling patients >65 years old (71 +/- 5 years, range 65-83 years) with established chronic CHID. Patient-reported physical function score (scaled 0-100) was measured by the Medical Outcomes Study Short Form physical function section. Independent variables included clinical and demographic data, treadmill testing, rest and exercise echocardiography, measures of body composition, strength, aerobic fitness, and a depression score.Results Patients with a diagnosis of myocardial infarction had a lower physical function score than did patients with other CHD diagnoses (68 +/- 19 vs 82 +/- 22, P < .05). Univariate predictors of patient-reported physical function score included peak aerobic capacity (R = 0.62), treadmill test duration (R = 0.61), depression score (R = -0.60), handgrip strength (R = 0.42), and comorbidity score (R = -0.39). Peak aerobic capacity (R-2 = 0.38) and depression score (cumulative R-2 = 0.60) were the best independent predictors of physical function. Women had lower physical function scores than men (64 +/- 22 vs 78 +/- 20, P < .05) despite a similar age, diagnostic distribution, depression score, and comorbidity score. Resting left ventricular ejection fraction was not a predictor of physical function score.Conclusions Peak aerobic capacity and depression score were the best independent predictors of patient-reported physical function score in older coronary patients. These data focus on the potential for exercise training and treatment of mental depression to prevent and treat coronary disability in older coronary patients.