Health status identifies heart failure outpatients at risk for hospitalization or death
Health status identifies heart failure outpatients at risk for hospitalization or death
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DOI：
10.1016/j.jacc.2005.11.021
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发表时间：
2006-02-21
影响因子：
24
通讯作者：
Williams, RE
中科院分区：
文献类型：
--
作者：
Heidenreich, PA;Spertus, JA;Williams, RE
目的研究堪萨斯城心肌病问卷(KCCQ)对门诊心力衰竭(HF)患者预后的影响。研究背景：KCCQ用于描述患者的临床状况，在某些人群中可预测死亡率。对于心力衰竭患者，它们的预后价值可能特别有用，以确定疾病治疗的候选者，在这些患者中，增加护理可以减少住院和预防死亡。方法我们使用KCCQ汇总评分评估了来自13个门诊诊所的505名射血分数均为40%的心力衰竭患者。结果平均年龄61岁，76%的患者为男性，51%的患者为缺血性心力衰竭病因，5%的患者为纽约心脏协会功能IV级。25，37%的患者因心力衰竭入院，20%的患者死亡，而KCCQ-Score=>；=75的患者的这一比例为7%(入院)和5%(死亡)(33%的患者，P<；0.0001用于两个比较)。在调整了临床变量、6分钟步行和BNP水平的序贯多变量模型中，KCCQ评分仍然与无心衰住院患者的生存率显著相关。结论KCCQ评分低是心力衰竭患者预后不良的独立预测因素。
OBJECTIVES We tested the hypothesis that one health status measure, the Kansas City Cardiomyopathy Questionnaire (KCCQ), provides prognostic information independent of other clinical data in outpatients with heart failure (HF).BACKGROUND Health status measures are used to describe a patient's clinical condition and have been shown to predict mortality in Some Populations. Their prognostic value may be particularly useful among patients with HF for identifying candidates for disease management in whom increased care may reduce hospitalizations and prevent death.METHODS We evaluated 505 HF patients from 13 outpatient clinics who had all ejection fraction < 40% using the KCCQ summary score. Proportional hazards regression was used to evaluate the association between the KCCQ summary score (range, 0 to 100; higher scores indicate better health status) and the primary outcome of death or HF admission, adjusting for baseline patient characteristics, 6-min walk distance, and B-type natriuretic peptide (BNP).RESULTS The mean age was 61 years, 76% of patients were male, 51% had an ischemic HF etiology, and 5% were New York Heart Association functional class IV. At 12 months, among the 9% of patients with a KCCQ-score < 25, 37% had been admitted for HF and 20% had died, compared with 7% (HF admissions) and 5% (death) of those with a KCCQ-score = >= 75 (33% of patients, p < 0.0001 for both comparisons). In sequential multivariable models adjusting for clinical variables, 6-min walk, and BNP levels, the KCCQ score remained significantly associated with survival free of HF hospitalization.CONCLUSIONS A low KCCQ score is an independent predictor of poor prognosis in outpatients with HF.