Improvement in health-related quality of life after hospitalization predicts event-free survival in patients with advanced heart failure.
Improvement in health-related quality of life after hospitalization predicts event-free survival in patients with advanced heart failure.
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DOI：
10.1016/j.cardfail.2009.05.003
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发表时间：
2009-11
影响因子：
6
通讯作者：
Stevenson, Lynne W.
中科院分区：
文献类型：
--
作者：
Moser, Debra K.;Yamokoski, Laura;Sun, Jie Lena;Conway, Ginger A.;Hartman, Karen A.;Graziano, Judith A.;Binanay, Cynthia;Stevenson, Lynne W.
健康相关生活质量（HRQOL）是心力衰竭（HF）患者的主要临床结局。我们的目的是确定失代偿性HF住院后HRQOL改善的频率、持久性和预后意义。我们分析了HRQOL，使用明尼苏达心力衰竭生活问卷（MLHFQ）连续测量，在肺动脉导管与临床评估的多中心随机临床试验中存活出院的425例患者，以指导晚期HF患者的治疗。入组的所有患者在入院时均有一次或多次既往HF住院或慢性高利尿剂剂量，以及一种或多种症状和一种液体超负荷体征。改善定义为MLHFQ总分降低5分以上，68%的患者在1个月时出现改善并稳定。6个月存活者与未存活者1个月改善程度差异有统计学意义（P<0.0001组×时间交互作用）。在考克斯回归模型中，校正HF发病率和死亡率的传统风险因素后，HRQOL改善1个月与恶化1个月或无变化相比预测随后的无事件生存时间（P=0.013）。在因重度HF失代偿而住院的患者中，HRQOL严重受损，但大多数患者在1个月内大幅改善，并在6个月内保持改善。对于入院后1个月HRQOL没有改善的患者，应特别关注改善HRQOL和解决无事件生存率差的高风险。
Health-related quality of life (HRQOL) is a major clinical outcome for heart failure (HF) patients. We aimed to determine the frequency, durability, and prognostic significance of improved HRQOL after hospitalization for decompensated HF. We analyzed HRQOL, measured serially using the Minnesota Living with Heart Failure Questionnaire (MLHFQ), for 425 patients who survived to discharge in a multicenter randomized clinical trial of pulmonary artery catheter versus clinical assessment to guide therapy for patients with advanced HF. All patients enrolled had one or more prior HF hospitalizations or chronic high diuretic doses and one or more symptom and one sign of fluid overload at admission. Improvement, defined as a decrease of more than 5 points in MLHFQ total score, occurred in 68% of patients by 1 month and stabilized. The degree of 1 month improvement differed (P<0.0001 group × time interaction) between 6 month survivors and non-survivors. In a Cox regression model, after adjustment for traditional risk factors for HF morbidity and mortality, improvement in HRQOL by 1 month compared to worsening at one month or no change predicted time to subsequent event-free survival (P=0.013). In patients hospitalized with severe HF decompensation, HRQOL is seriously impaired but improves substantially within 1 month for most patients and remains improved for 6 months. Patients for whom HRQOL does not improve by 1 month after hospital admission merit specific attention both to improve HRQOL and to address high risk for poor event-free survival.
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DOI：
10.1111/j.1532-5415.2000.tb03119.x
发表时间：
2000-05-01
影响因子：
6.3
作者：
Levenson, JW;McCarthy, EP;Phillips, RS
通讯作者：
Phillips, RS
影响因子：
2
作者：
Stull, DE;Clough, LA;Van Dussen, D
通讯作者：
Van Dussen, D
影响因子：
24
作者：
Heidenreich, PA;Spertus, JA;Williams, RE
通讯作者：
Williams, RE
影响因子：
8.9
作者：
Lewis, EF;Johnson, PA;Stevenson, LW
通讯作者：
Stevenson, LW
影响因子：
18.2
作者：
Alla, F;Briançon, S;Zannad, F
通讯作者：
Zannad, F