Advanced Diastolic Heart Failure: A Mixed-Methods Study of Older Women

背景：在美国500万心力衰竭（HF）患者中，10%为晚期疾病，定义为尽管接受了最佳治疗，但症状仍持续存在。75%的人年龄在65岁以上，老年女性的患病率高于男性。舒张性心力衰竭，现在被称为保留收缩功能的心力衰竭（HFPSF），在老年妇女中很常见。虽然在收缩期心衰的治疗方面取得了重大进展，但对于老年妇女HFPSF或晚期疾病的姑息治疗知之甚少。目的和具体目的：本混合方法研究的目的是描述老年晚期HFPSF妇女的特征和日常生活经历。具体目的是：1)描述老年HFPSF妇女样本的社会人口学和临床特征2)测量老年妇女样本的功能状态3)描述妇女的身体和情绪症状、舒适度和生活质量（QOL）并确定与（QOL）相关的变量4)检查晚期HF患者描述与自评症状、舒适度和生活质量之间的一致性。设计：这种混合方法设计将结合功能状态评估，三种定量工具和解释现象学的定性访谈方法。100名60岁及以上的晚期HFPSF女性将完成6分钟步行测试、明尼苏达州心力衰竭生活问卷（MLWHF）、心力衰竭纪念症状评估量表（MSAS-HF）和一般舒适度问卷（GCQ）。将对由20名妇女组成的小组进行深入访谈。将从妇女和医疗记录中获得社会人口和临床数据。数据分析：描述性统计将用于解决目标1-3，并将专门用于表征样本。将构建多元回归模型来识别与生活质量相关的变量。访谈数据分析将包括共同主题的识别、解释和范式的识别。将检查定性和定量数据是否一致。意义：老年女性HFPSF是一个研究不足的群体。研究解决老年妇女的经验与先进的HFPSF推进国家护理研究所的研究目标：提高临终体验的病人和他们的家人。公共卫生相关性：心力衰竭是一种心脏泵血效率受损的情况，是老年妇女的一个重要健康问题。当老年妇女心力衰竭恶化时，她们的特征和日常生活鲜为人知。增加对这些女性和她们经历的了解可能有助于找到增加她们舒适度的方法。

DESCRIPTION (provided by applicant): BACKGROUND: Of the 5 million persons in the United States with heart failure (HF), 10% have advanced disease, defined as persistent symptoms despite optimal treatment. Seventy-five percent are older than 65, with a higher prevalence in older women than men. Diastolic heart failure, now known as heart failure with preserved systolic function (HFPSF), is common in older women. While significant strides have been made in the management of systolic HF, little is known either about older women with HFPSF or about palliation in advanced disease. OBJECTIVE AND SPECIFIC AIMS: The purpose of this mixed methods study is to describe the characteristics and daily life experiences of older women with advanced HFPSF. Specific aims are to: 1) Describe the sociodemographic and clinical characteristics of a sample of older women with HFPSF 2) Measure the functional status of the sample of older women 3) Describe the women's physical and emotional symptoms, comfort and quality of life (QOL) and identify variables associated with (QOL) 4) Examine the congruence between patient descriptions of the advanced HF experience and self-rated symptoms, comfort and QOL. DESIGN: This mixed methods design will combine an assessment of functional status, three quantitative instruments and the qualitative interview method of interpretive phenomenology. One hundred women with advanced HFPSF, aged 60 and older, will complete a 6-Minute Walk Test, the Minnesota Living with Heart Failure Questionnaire (MLWHF), the Memorial Symptom Assessment Scale - Heart Failure (MSAS-HF) and the General Comfort Questionnaire (GCQ). A subgroup of 20 women will be interviewed in depth. Sociodemographic and clinical data will be obtained from the women and from medical records. DATA ANALYSIS: Descriptive statistics will be used to address aims 1-3, and will specifically be employed to characterize the sample. A multiple regression model will be constructed to identify variables associated with QOL. Interview data analysis will include identification of common themes, interpretation and identification of paradigms. Qualitative and quantitative data will be examined for congruence. SIGNIFICANCE: Older women with HFPSF are an understudied group. Research addressing the experience of older women with advanced HFPSF advances the National Institute for Nursing Research goal: Enhancing the End-of-Life Experience for Patients and their Families. PUBLIC HEALTH RELEVANCE: Heart failure, a condition of impaired heart pumping efficiency, is an important health issue for older women. Little is known about the characteristics and daily life of older women when heart failure worsens. Increasing understanding of these women and what they experience may help find ways to increase their comfort.