Preferences for quality of life or survival expressed by patients with heart failure
Preferences for quality of life or survival expressed by patients with heart failure
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DOI：
10.1016/s1053-2498(01)00298-4
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发表时间：
2001-09-01
影响因子：
8.9
通讯作者：
Stevenson, LW
中科院分区：
文献类型：
--
作者：
Lewis, EF;Johnson, PA;Stevenson, LW
背景资料：由于许多心力衰竭患者出现限制日常生活的症状，因此可能会发现新的治疗方法可改善功能状态，但不会带来生存获益。由于这些疗法中的一些实际上可能增加死亡率，因此评估患者对生存与症状改善的偏好越来越相关。方法：我们纳入了99例晚期心力衰竭患者（射血分数24 +/- 10，持续时间6 +/- 5年）。每位患者完成时间权衡和标准赌博工具，明尼苏达州生活与心力衰竭问卷和视觉模拟量表的呼吸困难和整体健康。颈静脉压进行了评估，在所有患者和峰值氧耗量进行了测量，在60 patients.Results：强烈的极性的偏好，无论是生存或生活质量的患者表示。时间权衡与标准Gamble效用评分（r = 0.64），偏好与功能分类（r = 0.60）之间存在良好的相关性。较高的颈静脉压和较低的峰值耗氧量与较差的效用评分相关（p <0.05）。更高的呼吸困难评分和更差的生活与心力衰竭评分也与贸易时间的偏好或更好的health.Conclusions承担风险：这些研究结果表明，心力衰竭患者表达有意义的偏好质量与生命的长度。高颈静脉压、低峰值耗氧量和心力衰竭生存评分差与低效用评分相关。然而，这些不能被假定为预测个人偏好的强度，即为了更好的健康而什么都不做或几乎什么都做。
Background: As many patients with heart failure develop symptoms limiting daily life, newer therapies may be found to improve functional status without concomitant survival benefit. As some of these therapies may actually increase mortality, it is increasingly relevant to assess patients' preferences for survival vs improvement in symptoms.Methods: We enrolled 99 patients with advanced heart failure (ejection fraction 24 +/- 10, duration 6 +/- 5 years). Each patient completed time trade-off and standard gamble instruments, Minnesota Living with Heart Failure questionnaires and visual analog scales for dyspnea and overall health. Jugular venous pressure was assessed in all patients and peak oxygen consumption was measured during bicycle exercise in 60 patients.Results: Strong polarity of preference toward either survival or quality of life was expressed by 60% of patients. There was good correlation between time trade-off and standard gamble utility scores (r = 0.64), and between preference and functional class (r = 0.60). Higher jugular venous pressure and lower peak oxygen consumption were associated with poorer utility scores (p < .05). Higher dyspnea scores and worse Living with Heart Failure scores were also associated with preference to trade time or take risks for better health.Conclusions: These findings suggest that heart failure patients express meaningful preferences about quality vs length of life. High jugular venous pressure, low peak oxygen consumption and poor Living with Heart Failure scores were related to low utility scores. These cannot be assumed, however, to predict the intensity of individual preference to trade nothing or virtually everything for better health.