Sarkar Urmimala, Ali Sadia, Whooley Mary A
Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, Box 1732, San Francisco, CA 94143-1732, USA.
Health Psychol. 2009 Mar;28(2):166-73. doi: 10.1037/a0013146.
The authors sought to evaluate the association of self-efficacy with objective measures of cardiac function, subsequent hospitalization for heart failure (HF), and all-cause mortality.
Observational cohort of ambulatory patients with stable CHD. The authors measured self-efficacy using a published, validated, 5-item summative scale, the Sullivan Self-Efficacy to Maintain Function Scale. The authors also performed a cardiac assessment, including an exercise treadmill test with stress echocardiography.
Hospitalizations for HF, as determined by blinded review of medical records, and all-cause mortality, with adjustment for demographics, medical history, medication use, depressive symptoms, and social support.
Of the 1,024 predominately male, older CHD patients, 1013 (99%) were available for follow-up, 124 (12%) were hospitalized for HF, and 235 (23%) died during 4.3 years of follow-up. Mean cardiac self-efficacy score was 9.7 (SD 4.5, range 0-20), corresponding to responses between "not at all confident" and "somewhat confident" for ability to maintain function. Lower self-efficacy predicted subsequent HF hospitalization (OR per SD decrease = 1.4, p = .0006), and all-cause mortality (OR per SD decrease = 1.4, p < .0001). After adjustment, the association of cardiac self-efficacy with both HF hospitalization and mortality was explained by worse baseline cardiac function.
Among patients with CHD, self-efficacy was a reasonable proxy for predicting HF hospitalizations. The increased risk of HF associated with lower baseline self-efficacy was explained by worse cardiac function. These findings indicate that measuring cardiac self-efficacy provides a rapid and potentially useful assessment of cardiac function among outpatients with CHD.
作者试图评估自我效能感与心脏功能客观指标、随后因心力衰竭（HF）住院以及全因死亡率之间的关联。
对稳定型冠心病门诊患者的观察性队列研究。作者使用已发表的、经过验证的5项汇总量表（沙利文维持功能自我效能量表）来测量自我效能感。作者还进行了心脏评估，包括运动平板试验及负荷超声心动图检查。
通过对病历的盲法审查确定的HF住院情况以及全因死亡率，并对人口统计学、病史、用药情况、抑郁症状和社会支持进行了调整。
在1024例以男性为主的老年冠心病患者中，1013例（99%）可供随访，124例（12%）因HF住院，235例（23%）在4.3年的随访期间死亡。心脏自我效能感平均得分为9.7（标准差4.5，范围0 - 20），对应于维持功能能力方面“完全不自信”到“有些自信”之间的回答。较低的自我效能感预示着随后的HF住院（每标准差降低的比值比 = 1.4，p = 0.0006）以及全因死亡率（每标准差降低的比值比 = 1.4，p < 0.0001）。调整后，较差的基线心脏功能解释了心脏自我效能感与HF住院和死亡率之间的关联。
在冠心病患者中，自我效能感是预测HF住院的合理指标。基线自我效能感较低与HF风险增加之间的关联可由较差的心脏功能来解释。这些发现表明，测量心脏自我效能感为冠心病门诊患者的心脏功能提供了一种快速且可能有用的评估方法。
