Department of Cardiology, St Vincent's University Hospital, Dublin, Ireland.
Int J Cardiol. 2010 Feb 18;139(1):60-7. doi: 10.1016/j.ijcard.2008.09.003. Epub 2008 Oct 12.
Chronic heart failure (HF) is associated with a poor Health Related Quality of Life (HRQoL). HRQoL has been shown to be a predictor of HF outcomes however, variability in the study designs make it difficult to apply these findings to a clinical setting. The aim of this study was to establish if HRQoL is a predictor of long-term mortality and morbidity in HF patients followed-up in a disease management program (DMP) and if a HRQoL instrument could be applied to aid in identifying high-risk patients within a clinical context.
This is a retrospective analysis of HF patients attending a DMP with 18+/-9 months follow-up. Clinical and biochemical parameters were recorded on discharge from index HF admission and HRQoL measures were recorded at 2 weeks post index admission.
225 patients were enrolled into the study (mean age=69+/-12 years, male=61%, and 78%=systolic HF). In multivariable analysis, all dimensions of HRQoL (measured by the Minnesota Living with HF Questionnaire) were independent predictors of both mortality and readmissions particularly in patients <80 years. A significant interaction between HRQoL and age (Total((HRQoL))age: p<0.001) indicated that the association of HRQoL with outcomes diminished as age increased.
These data demonstrate that HRQoL is a predictor of outcome in HF patients managed in a DMP. Younger patients (<65 years) with a Total HRQoL score of > or =50 are at high risk of an adverse outcome. In older patients > or =80 years HRQoL is not useful in predicting outcome.
慢性心力衰竭（HF）与较差的健康相关生活质量（HRQoL）有关。已经表明，HRQoL 是 HF 结局的预测因素，但是研究设计的变异性使得难以将这些发现应用于临床环境。本研究旨在确定 HRQoL 是否可以预测接受疾病管理计划（DMP）随访的 HF 患者的长期死亡率和发病率，以及是否可以应用 HRQoL 工具来帮助在临床环境中识别高风险患者。
这是对参加 DMP 的 HF 患者进行的回顾性分析，随访时间为 18+/-9 个月。在指数 HF 入院时记录临床和生化参数，并在指数入院后 2 周记录 HRQoL 测量值。
共有 225 名患者入组研究（平均年龄=69+/-12 岁，男性=61%，78%=收缩性 HF）。在多变量分析中，HRQoL 的所有维度（通过明尼苏达州心力衰竭生活质量问卷测量）都是死亡率和再入院的独立预测因素，特别是在<80 岁的患者中。HRQoL 和年龄之间存在显著的交互作用（总（HRQoL）年龄：p<0.001），表明随着年龄的增长，HRQoL 与结局的关联减弱。
这些数据表明，HRQoL 是 DMP 管理的 HF 患者结局的预测因素。在接受 DMP 治疗的年轻患者（<65 岁）中，总 HRQoL 评分>或=50 的患者发生不良结局的风险较高。对于>或=80 岁的老年患者，HRQoL 对预测结局没有帮助。
