University of Kentucky, Lexington, KY 40536-0232, United States.
Eur J Cardiovasc Nurs. 2011 Jun;10(2):124-9. doi: 10.1016/j.ejcnurse.2010.05.006. Epub 2010 Jul 15.
Inability of heart failure (HF) patients to recognize worsening symptoms that herald an exacerbation is a common reason for HF readmissions.
To examine the relationship between patterns of HF symptom variability, and HF event-free survival.
Patients with HF (N=71) rated HF symptoms daily for 30 days. Symptoms were rated on a 10 point scale anchored at the extreme ends by "worst symptom could be" and "best symptom could be". Patients were followed for an average of 1 year to track HF and cardiac rehospitalizations and all-cause mortality.
Cox regression comparing event-free survival between patients who had highly variable symptom ratings across the 30-days and those whose symptoms were less variable revealed worse event-free survival in patients with more variable symptoms of shortness of breath or edema. Symptom variability predicted event-free survival independently of severity of symptoms, ejection fraction, comorbidities, age and gender. Symptom severity did not predict rehospitalization or mortality.
Regardless of symptom severity, patients whose symptoms fluctuated in an improving and worsening pattern were at substantially greater risk for poorer event-free survival. These patients may become accustomed to this pattern such that they expect symptoms to improve and thus do not seek treatment with worsening symptoms.
心力衰竭（HF）患者无法识别预示病情恶化的症状加重，这是 HF 再入院的常见原因。
探讨 HF 症状变异性模式与 HF 无事件生存之间的关系。
71 例 HF 患者每天对 HF 症状进行评分，为期 30 天。症状评分采用 10 分制，两端分别为“症状最重可能是”和“症状最轻可能是”。对患者进行平均 1 年的随访，以跟踪 HF 及心脏再入院和全因死亡率。
与 30 天内症状评分变化较大的患者相比，症状变化较小的患者无事件生存时间更长。在呼吸困难或水肿症状变化较大的患者中，无事件生存时间更差。症状变异性独立于症状严重程度、射血分数、合并症、年龄和性别预测无事件生存。症状严重程度不能预测再住院或死亡率。
无论症状严重程度如何，症状呈改善和恶化波动模式的患者无事件生存的风险显著增加。这些患者可能已经习惯了这种模式，因此在症状恶化时不会寻求治疗。
