Device-detected congestion is associated with worse patient-reported outcomes in heart failure.
Device-detected congestion is associated with worse patient-reported outcomes in heart failure.
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DOI：
10.1016/j.hrtlng.2018.12.003
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发表时间：
2019-05
期刊：
影响因子：
--
通讯作者：
Lee CS
中科院分区：
文献类型：
--
作者：
Auld JP;Mudd JO;Gelow JM;Lyons KS;Hiatt SO;Lee CS
充血是心力衰竭（HF）症状的常见原因。然而，胸内阻抗，心肺充血的客观标志物，还没有被检查与HF症状。量化3个月以上HF成人患者的身体和情感症状、健康相关生活质量（HRQOL）和器械检测到的心肺充血之间的关系。多变量广义线性模型被用来量化心肺充血的相关性（Optivol®指数超过60分阈值），HRQOL（12项堪萨斯城心肌病问卷）和身体症状（慢性病治疗功能评估-疲劳量表; HF躯体感觉量表呼吸困难和早期和微妙症状子量表）和情感症状（9项患者健康问卷; 6项患者报告结局测量信息系统焦虑量表）。样本的平均年龄（n=49）为62岁，39%为女性，63%为NYHA III/IV级HF。在过去90天内经历过阈值交叉的参与者平均报告呼吸困难增加130%（p=0.017;置信区间（CI）10.2%，437%），早期和轻微症状高40%（p=0.029; CI 3.4%，89.7%），抑郁症状增加106%（p=0.003; CI 19.1%，257%），焦虑增加40%（p=0.028; CI 3.7%，89.1%）。过去90天内的阈值交叉也与HRQOL具有临床意义的降低显著相关（β=16.16±6.32; p=0.01）。采用Optivol指数测量的胸内阻抗可提供关于患者在3个月内的标志性身体和心理HF症状和HRQOL的额外信息。
Congestion is a common cause of symptoms in heart failure (HF). Yet, intrathoracic impedance, an objective marker of cardiopulmonary congestion, has not been examined in relation to HF symptoms. To quantify relationships among physical and affective symptoms, health-related quality of life (HRQOL) and device-detected cardiopulmonary congestion in adults with HF over 3 months. Multivariate generalized linear modeling was used to quantify the association of cardiopulmonary congestion (Optivol® Index exceeding 60 Ω threshold) with HRQOL (12-item Kansas City Cardiomyopathy Questionnaire) and both physical symptoms (Functional Assessment of Chronic Illness Therapy-Fatigue Scale; HF Somatic Perception Scale Dyspnea and Early & Subtle Symptoms subscales) and affective symptoms (9-item Patient Health Questionnaire; 6-item Patient-Reported Outcomes Measurement Information System Anxiety Scale). The mean age of the sample (n=49) was 62 years old, 39% were women, and 63% had NYHA class III/IV HF. Participants who experienced threshold crossings in the previous 90 days reported on average, 130% higher dyspnea (p=0.017; confidence interval (CI) 10.2%, 437%), 40% higher early & subtle symptoms (p=0.029; CI 3.4%, 89.7%), 106% higher depressive symptoms (p=0.003; CI 19.1%, 257%) and 40% higher anxiety (p=0.028; CI 3.7%, 89.1%). Threshold crossings in the previous 90 days were also significantly associated with a clinically meaningful decrease in HRQOL (β=16.16±6.32; p=0.01). Intrathoracic impedance measured with the Optivol Index can provide additional information regarding the patient experience of hallmark physical and psychological HF symptoms and HRQOL over 3 months.
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