Austin Bethany A, Wang Yongfei, Smith Grace L, Vaccarine Viola, Krumholz Harlan M, McNamara Robert L
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA.
Clin Cardiol. 2008 Mar;31(3):119-24. doi: 10.1002/clc.20118.
Patients with heart failure (HF) and preserved ejection fraction (EF) have been shown to have high mortality rates, comparable to those with reduced EF. Thus, long-term survivors of HF, regardless of ejection fraction, are a select group. Little is known about disease-related quality of life (QOL) and health status in these patients.
Preserved EF in patients with heart failure independently predicts long-term survival, health related quality of life (QOL), or functional status.
The study followed a cohort of 413 patients consecutively hospitalized for HF between March 1996 and September 1998. In July 2005, information was collected about their mortality, health related QOL as defined by disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, and functional decline as defined by limitations in Activities of Daily Living (ADL) scores.
The primary outcomes were mortality, QOL, and functional decline. At follow-up, 8.1 years after enrollment, overall mortality was 76% (314/413). Adjusted for age, gender, renal insufficiency, diabetes mellitus, hypertension, HF, and respiratory disease, those with decreased ejection fraction (EF < 40%) had higher mortality compared with those with preserved ejection fraction (hazard ratio [HR] 1.42; confidence interval [CI] = 1.13, 1.80, p = 0.003). The KCCQ scores, including Clinical Summary Scores and Symptom Limitation Scores, as well as ADL limitations, were not significantly different in the survivors with preserved or decreased EF.
Heart failure patients with preserved EF have a modest survival advantage compared with those with decreased EF, but health related QOL scores and functional decline in survivors are similar regardless of systolic function.
心力衰竭（HF）且射血分数（EF）保留的患者已被证明具有较高的死亡率，与射血分数降低的患者相当。因此，无论射血分数如何，HF的长期幸存者都是一个特殊群体。对于这些患者与疾病相关的生活质量（QOL）和健康状况知之甚少。
心力衰竭患者保留的EF独立预测长期生存、健康相关生活质量（QOL）或功能状态。
该研究对1996年3月至1998年9月期间因HF连续住院的413名患者进行了队列研究。2005年7月，收集了他们的死亡率、由特定疾病的堪萨斯城心肌病问卷（KCCQ）评分定义的健康相关QOL以及由日常生活活动（ADL）评分限制定义的功能下降情况。
主要结局为死亡率、QOL和功能下降。在随访中，入组8.1年后，总死亡率为76%（314/413）。在对年龄、性别、肾功能不全、糖尿病、高血压、HF和呼吸系统疾病进行校正后，射血分数降低（EF<40%）的患者与射血分数保留的患者相比死亡率更高（风险比[HR]1.42；置信区间[CI]=1.13，1.80，p = 0.003）。在射血分数保留或降低的幸存者中，KCCQ评分，包括临床总结评分和症状限制评分，以及ADL限制并无显著差异。
与射血分数降低的心力衰竭患者相比，射血分数保留的心力衰竭患者具有适度的生存优势，但无论收缩功能如何，幸存者的健康相关QOL评分和功能下降情况相似。
