Symptom distress and quality of life in patients with advanced congestive heart failure
Symptom distress and quality of life in patients with advanced congestive heart failure
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DOI：
10.1016/j.jpainsymman.2007.06.007
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发表时间：
2008-06-01
影响因子：
4.7
通讯作者：
Tennstedt, Sharon L.
中科院分区：
文献类型：
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作者：
Blinderman, Craig D.;Hornel, Peter;Tennstedt, Sharon L.
关于晚期充血性心力衰竭（CHF）的疾病负担知之甚少。了解这一人群的需求需要进一步了解症状和其他与生活质量相关的因素。我们研究了103例社区居住的纽约心脏协会III/IV级CHF患者的便利样本。主要结局，生活质量，用多维生活质量指数测量。生活质量的潜在相关因素包括总体症状负担（记忆症状评估量表，MSAS），包括全球症状困扰（MSAS全球困扰指数，GDI）;心理状态（心理健康量表-5）;功能状态（疾病影响概况）;灵性（慢性病治疗功能评估-灵性量表）;和共病（Charlson合并症指数）。患者的平均年龄为67.1岁（SD = 12.1）;大多数为白色（72.8%）、男性（71.8%）和已婚（51.5%）;平均射血分数为22.3%（SD = 6.8）。最常见的症状是缺乏能量（66%）、口干（62%）、呼吸急促（56%）和困倦（52%）。约三分之一的患者报告疼痛。对于这些症状中的每一个，14.1%-54.1%的人报告了与抑郁症相关的高度痛苦。生活质量中度受损（多维生活质量综合指数，中位数= 56，可能范围12-84）。生活质量受损与总体症状困扰密切相关（MSAS GDI; r = 0.74，P < 0.001）;共病负担（r =-0.32，P = 0.002），女性功能障碍，尤其是心理障碍（r =-0.55，P <0.001），心理健康状况较差（r = 0.68，P < 0.001）。在多变量分析中，生活质量受损与高症状困扰、较差的心理健康和较差的功能活动性显著相关（R-2 = 0.67; P = 0.002）。与生活质量受损相关的痛苦症状包括缺乏能量（P = 0.04）、易怒（P = 0.03）和嗜睡（P = 0.02）。社区居住的晚期CHF患者会出现多种症状、严重的症状困扰和生活质量受损。总体生活质量与症状困扰、心理健康和功能状态密切相关。关注改善普遍的身体症状和心理困扰，沿着促进功能活动的支持性措施，可能会改善该患者人群的整体生活质量。
Little is known about the burden of illness associated with advanced congestive heart failure (CHF). Understanding the needs of this population requires further information about symptoms and other factors related to quality of life. We studied a convenience sample of 103 community-dwelling patients with New York Heart Association Class III/IV CHF. The primary outcome, quality of life, was measured with the Multidimensional Index of Life Quality. Potential correlates of quality of life included overall symptom burden (Memorial Symptom Assessment Scale, MSAS), including global symptom distress (MSAS Global Distress Index, GDI); psychological state (Mental Health Inventory-5); functional status (Sickness Impact Profile); spirituality (Functional Assessment of Chronic Illness Therapy-Spirituality Scale); and co-morbid conditions (Charlson Comorbidity Index). Patients had a mean age of 67.1 years (SD = 12.1); were mostly white (72.8%), male (71.8%), and married (51.5%); and had a mean ejection fraction of 22.3% (SD = 6 8). The most prevalent symptoms were lack of energy (66 %), dry mouth (62 %), shortness of breath (56 %), and drowsiness (52 %). Pain was reported by about one-third of patients. For each of these symptoms, high symptom-related distress was reported by 14.1%-54.1%. Quality of life was moderately compromised (Multidimensional Index of Life Quality composite, median = 56, possible range 12-84). Impairment in quality of life was strongly associated with global symptom distress (MSAS GDI; r = 0.74, P < 0.001); burden of comorbid conditions (r = -0.32, P = 0.002), female sex (r = -0.22, P = 0.03), functional impairment, particularly psychological impairment (r = -0.55, P < 0.001), and poorer psychological well-being (r = 0.68, P < 0.001). In multivariate analyses, impairment in quality of life was significantly related to high symptom distress, poorer psychological well-being, and poor functional mobility (R-2 = 0.67; P = 0.002 for all). Distressful symptoms related to impaired quality of life included lack of energy (P = 0.04), irritability (P = 0.03), and drowsiness (P = 0.02). Community-dwelling patients with advanced CHF experience numerous symptoms, significant symptom distress, and a compromised quality of life. Overall quality of life was strongly associated with symptom distress, psychological well-being and functional status. A focus on ameliorating prevalent physical symptoms and psychological distress, along with supportive measures that promote functional mobility, may lead to an improvement in the overall quality of life in this patient population.