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

描述(由申请人提供)：背景：在美国的500万心力衰竭(HF)患者中，10%的人患有晚期疾病，定义为尽管进行了最佳治疗，但仍有持续性症状。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，现在被称为收缩功能保留的心力衰竭(HFPSF)，在老年女性中很常见。虽然在治疗收缩期心衰方面取得了重大进展，但对患有HFPSF的老年妇女或晚期疾病的姑息治疗知之甚少。目的和具体目的：这项混合方法研究的目的是描述患有晚期HFPSF的老年妇女的特征和日常生活经历。具体目的是：1)描述患有HFPSF的老年女性样本的社会人口学和临床特征2)测量老年女性样本的功能状况3)描述女性的身体和情感症状、舒适度和生活质量(QOL)，并确定与其相关的变量(QOL)4)检查患者对高级心力衰竭经历的描述与自测症状、舒适度和生活质量之间的一致性。设计：此混合方法设计将结合功能状态评估、三种量化工具和解释现象学的定性访谈方法。100名60岁及以上患有晚期HFPSF的女性将完成6分钟步行测试、明尼苏达州心力衰竭生活问卷(MLWHF)、纪念症状评估量表-心力衰竭(MSAS-HF)和一般舒适度问卷(GCQ)。由20名女性组成的小组将接受深入采访。社会人口学和临床数据将从妇女和医疗记录中获得。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。将构建一个多元回归模型来确定与生活质量相关的变量。访谈数据分析将包括确定共同主题、解释和确定范例。将检查定性和定量数据的一致性。意义：患有HFPSF的老年女性是一个研究不足的群体。针对患有晚期HFPSF的老年妇女的经验的研究推进了国家护理研究所的目标：增强患者及其家人的临终体验。公共卫生相关性：心力衰竭是心脏泵血效率受损的一种情况，对老年妇女来说是一个重要的健康问题。当心力衰竭恶化时，人们对老年女性的特征和日常生活知之甚少。增加对这些女性的了解和她们的经历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.