Stevenson Lynne W, Hellkamp Anne S, Leier Carl V, Sopko George, Koelling Todd, Warnica J Wayne, Abraham William T, Kasper Edward K, Rogers Joseph G, Califf Robert M, Schramm Elizabeth E, O'Connor Christopher M
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
J Am Coll Cardiol. 2008 Nov 18;52(21):1702-8. doi: 10.1016/j.jacc.2008.08.028.
This study was designed to analyze how patient preferences for survival versus quality-of-life change after hospitalization with advanced heart failure (HF).
Although patient-centered care is a priority, little is known about preferences to trade length of life for quality among hospitalized patients with advanced HF, and it is not known how those preferences change after hospitalization.
The time trade-off utility, symptom scores, and 6-min walk distance were measured in 287 patients in the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheter Effectiveness) trial at hospitalization and again during 6 months after therapy to relieve congestion.
Willingness to trade was bimodal. At baseline, the median trade for better quality was 3 months' survival time, with a modest relation to symptom severity. Preference for survival time was stable for most patients, but increase after discharge occurred in 98 of 145 (68%) patients initially willing to trade survival time, and was more common with symptom improvement and after therapy guided by pulmonary artery catheters (p = 0.034). Adjusting days alive after hospital discharge for patients' survival preference reduced overall days by 24%, with the largest reduction among patients dying early after discharge (p = 0.0015).
Preferences remain in favor of survival for many patients despite advanced HF symptoms, but increase further after hospitalization. The bimodal distribution and the stability of patient preference limit utility as a trial end point, but support its relevance in design of care for an individual patient.
本研究旨在分析晚期心力衰竭（HF）患者住院后在生存与生活质量方面的偏好变化。
尽管以患者为中心的护理是优先事项，但对于晚期HF住院患者用生命长度换取生活质量的偏好知之甚少，且这些偏好在住院后如何变化也不清楚。
在充血性心力衰竭和肺动脉导管有效性评估研究（ESCAPE）试验中的287例患者住院时以及缓解充血治疗后的6个月内，测量了时间权衡效用、症状评分和6分钟步行距离。
权衡意愿呈双峰分布。基线时，为换取更好生活质量的生存时间中位数为3个月，与症状严重程度呈适度相关。大多数患者对生存时间的偏好保持稳定，但在最初愿意用生存时间进行权衡的145例患者中，有98例（68%）在出院后偏好增加，且在症状改善以及肺动脉导管引导的治疗后更为常见（p = 0.034）。根据患者的生存偏好调整出院后的存活天数，总体天数减少了24%，在出院后早期死亡的患者中减少幅度最大（p = 0.0015）。
尽管存在晚期HF症状，许多患者仍偏好生存，但住院后这种偏好进一步增加。双峰分布和患者偏好的稳定性限制了将效用作为试验终点，但支持其在个体患者护理设计中的相关性。
