Masoudi Frederick A, Rumsfeld John S, Havranek Edward P, House John A, Peterson Eric D, Krumholz Harlan M, Spertus John A
Department of Medicine, Denver Health Medical Center, Colorado 80204, USA.
J Card Fail. 2004 Oct;10(5):368-73. doi: 10.1016/j.cardfail.2004.01.009.
Although heart failure disproportionately affects older persons and is associated with significant physical disability, existing data on physical limitations and health-related quality of life (HRQL) derive largely from studies of younger subjects. We compared the relationship between functional limitation and HRQL between older and younger patients with heart failure.
We evaluated 546 outpatients with heart failure enrolled in a multicenter prospective cohort study. At baseline and 6 +/- 2 weeks later, functional status was assessed by New York Heart Association (NYHA) classification and 6-minute walk testing. HRQL was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ). Comparing older (age >65 years, n = 218) and younger patients (n = 328), we assessed baseline HRQL across strata of functional status. In the 484 patients who completed follow-up (194 older and 290 younger patients), we also assessed the changes in HRQL associated with changes in functional status over time. At baseline, older patients had better HRQL than younger patients (mean KCCQ score 60 +/- 25 versus 54 +/- 28, P = .005) in spite of worse NYHA class (mean 2.54 versus 2.35, P < .001) and lower 6-minute walk distances (824 +/- 378 versus 1064 +/- 371 feet, P < .001). After multivariable adjustment including baseline NYHA class, older age was independently correlated with better HRQL (beta = +7.9 points, P < .001). At follow-up, older patients with a deterioration in NYHA class experienced marked declines in HRQL compared with younger patients (mean HRQL change of -14.4 points versus +0.3 points, respectively, P < .001). Analyses using 6-minute walk distance as the functional measure yielded similar results.
Although older patients with heart failure have relatively good HRQL in spite of significant functional limitations, they are at risk for worsening HRQL with further decline in functional status. These results underscore the importance of treatments aimed at maintaining functional status in older persons with heart failure, including those with significant baseline functional limitations.
尽管心力衰竭对老年人的影响尤为严重，且与严重的身体残疾相关，但现有的关于身体功能受限和健康相关生活质量（HRQL）的数据主要来自对年轻受试者的研究。我们比较了老年和年轻心力衰竭患者功能受限与HRQL之间的关系。
我们评估了纳入一项多中心前瞻性队列研究的546例心力衰竭门诊患者。在基线时以及6±2周后，通过纽约心脏协会（NYHA）分级和6分钟步行试验评估功能状态。使用堪萨斯城心肌病问卷（KCCQ）测量HRQL。比较老年患者（年龄>65岁，n = 218）和年轻患者（n = 328），我们评估了不同功能状态分层的基线HRQL。在完成随访的484例患者（194例老年患者和290例年轻患者）中，我们还评估了随时间推移HRQL与功能状态变化相关的改变。在基线时，尽管老年患者的NYHA分级更差（平均2.54比2.35，P <.001）且6分钟步行距离更低（824±378比1064±371英尺，P <.001），但他们的HRQL比年轻患者更好（平均KCCQ评分60±25比54±28，P =.005）。经过包括基线NYHA分级在内的多变量调整后，高龄与更好的HRQL独立相关（β = +7.9分，P <.001）。在随访时，NYHA分级恶化的老年患者与年轻患者相比，HRQL显著下降（平均HRQL变化分别为-14.4分和+0.3分，P <.001）。使用6分钟步行距离作为功能指标的分析得出了类似结果。
尽管患有心力衰竭的老年患者尽管存在明显的功能受限，但HRQL相对较好，但随着功能状态的进一步下降，他们有HRQL恶化的风险。这些结果强调了针对维持老年心力衰竭患者功能状态的治疗的重要性，包括那些基线功能受限严重的患者。
