Health-Related Quality of Life, Functional Status, and Cardiac Event-Free Survival in Patients With Heart Failure.
Health-Related Quality of Life, Functional Status, and Cardiac Event-Free Survival in Patients With Heart Failure.
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DOI：
10.1097/jcn.0000000000000248
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发表时间：
2016-05
期刊：
影响因子：
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通讯作者：
Moser DK
中科院分区：
文献类型：
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作者：
Wu JR;Lennie TA;Frazier SK;Moser DK
健康相关生活质量（HRQOL）、功能状态和无心脏事件生存期是用于评估心力衰竭（HF）患者干预措施有效性的结局。然而，HRQOL、功能状态和无心脏事件生存期之间关系的性质仍不清楚。本研究的目的是检查HF患者的HRQOL、功能状态和无心脏事件生存期之间的关系。这是一项纳入313例HF患者的前瞻性、观察性研究，是一项登记研究的次要分析。在基线时，收集患者人口统计学和临床数据。使用明尼苏达心力衰竭生活质量问卷（MLHFQ）评估HRQOL，使用杜克活动状态指数（DASI）测量功能状态。通过患者访谈、医院数据库和死亡证明审查获得无心脏事件生存数据。采用多元线性和考克斯回归分析探讨HRQOL、功能状态和无心脏事件生存期之间的关系，同时调整人口统计学和临床因素。参与者（n = 313）为男性（69%），白人（79%），年龄62 ± 11岁。平均左心室射血分数（LVEF）为35 ± 14%。平均HRQOL评分为32.3 ± 20.6，表明HRQOL较差。平均DASI评分为16.2 ± 12.9，表明功能状态较差。HRQOL较差或功能状态较差的患者的无心脏事件生存率显著较差。功能状态较好的患者HRQOL较好（p <0.001）。HRQOL不是模型中进入功能状态后无心脏事件生存期的显著预测因子（p = 0.54），表明它是HRQOL与结局之间关系的中介。功能状态是HRQOL和无心脏事件生存率之间的中介。这些数据表明，需要进行干预研究以改善功能状态。
Health-related quality of life (HRQOL), functional status, and cardiac event-free survival are outcomes used to assess the effectiveness of interventions in patients with heart failure (HF). However, the nature of the relationships among HRQOL, functional status and cardiac event-free survival remains unclear. The purpose of this study was to examine the nature of the relationships among HRQOL, functional status, and cardiac event-free survival in patients with HF. This was a prospective, observational study of 313 patients with HF that was a secondary analysis from a registry. At baseline, patient demographic and clinical data were collected. HRQOL was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and functional status was measured using the Duke Activity Status Index (DASI). Cardiac event-free survival data were obtained by patient interview, hospital database and death certificate review. Multiple linear and Cox regressions were used to explore the relationships among HRQOL, functional status and cardiac event-free survival while adjusting for demographic and clinical factors. Participants (n = 313) were male (69%), Caucasians (79%), and aged 62 ± 11 years. Mean left ventricular ejection fraction of (LVEF) was 35 ± 14%. Mean HRQOL score of 32.3 ± 20.6 indicated poor HRQOL. Mean DASI score of 16.2 ± 12.9 indicated poor functional status. Cardiac event-free survival was significantly worse in patients who had worse HRQOL or poorer functional status. Patients who had better functional status had better HRQOL (p <.001). HRQOL was not a significant predictor of cardiac event-free survival after entering functional status in the model (p = .54) demonstrating that it was a mediator of the relationship between HRQOL and outcome. Functional status was a mediator between HRQOL and cardiac event-free survival. These data suggest intervention studies to improve functional status are needed.