Hauptman Paul J, Masoudi Frederick A, Weintraub William S, Pina Ileana, Jones Philip G, Spertus John A
Department of Medicine, Saint Louis University School of Medicine, Missouri, USA.
J Card Fail. 2004 Oct;10(5):397-402. doi: 10.1016/j.cardfail.2003.12.008.
The importance of repeated clinical assessments of patients with heart failure is widely accepted. The frequency of such follow-up is not established and is likely to depend on the natural history and variability of patients' health status and the availability and use of appropriate treatments.
We analyzed data from a multicenter prospective cohort study of heart failure outpatients comparing baseline variables including New York Heart Association (NYHA) class, summary score on the Kansas City Cardiomyopathy Questionnaire (KCCQ), and performance on a 6-minute walk test with results of a repeat evaluation at 6 weeks. We also compared patient and physician assessment of change in disease status among patients with advanced symptoms (NYHA class III with a recent antecedent hospitalization or class IV) and those with milder degrees of limitation (NYHA classes I, II, and stable III). Patients with advanced symptoms had greater short-term variability in health status as reflected by the KCCQ summary score and a visual analog scale. A greater proportion of patients with advanced heart failure experienced moderate or greater clinical change. Patient and physician global assessments were congruent with more direct measures of health status.
Patients with advanced heart failure have greater short-term variability in status, supporting the need for frequent clinical follow-up and appropriate power calculations for clinical trials that are designed to measure meaningful changes over a short period.
对心力衰竭患者进行反复临床评估的重要性已得到广泛认可。此类随访的频率尚未确定，可能取决于患者健康状况的自然史和变异性以及适当治疗方法的可获得性和使用情况。
我们分析了一项针对心力衰竭门诊患者的多中心前瞻性队列研究的数据，比较了包括纽约心脏协会（NYHA）分级、堪萨斯城心肌病问卷（KCCQ）总结评分以及6分钟步行试验表现等基线变量与6周后重复评估的结果。我们还比较了晚期症状患者（NYHA III级且近期有过住院或IV级）和症状较轻患者（NYHA I、II级以及稳定的III级）中患者和医生对疾病状态变化的评估。如KCCQ总结评分和视觉模拟量表所示，晚期症状患者的健康状况在短期内变异性更大。更大比例的晚期心力衰竭患者经历了中度或更大程度的临床变化。患者和医生的整体评估与更直接的健康状况测量结果一致。
晚期心力衰竭患者的病情在短期内变异性更大，这支持了对其进行频繁临床随访的必要性，以及在旨在测量短期内有意义变化的临床试验中进行适当功效计算的必要性。
