Heart Failure Program, Lancaster General Hospital, The Heart Group, Lancaster, PA 17603, USA.
J Cardiovasc Nurs. 2011 Jul-Aug;26(4):E20-6. doi: 10.1097/JCN.0b013e3181ee28c8.
Effective self-care is regarded as essential to the management of heart failure (HF). The influence of self-care on HF decompensation, however, is not well understood. Accordingly, we examined the relationship between self-care and fluid accumulation accompanying worsening HF as indexed by decreasing intrathoracic impedance (Z).
Z data were collected from 58 HF patients with OptiVol enabled devices (Medtronic Inc, Minneapolis, Minnesota). Heart failure self-care was measured with the European Heart Failure Self-care Behaviour Scale. Regression modeling was used to describe the influence of HF self-care on the likelihood of a fluid index (FI) threshold crossing, the number of threshold crossings, and number of days spent above threshold.
Patients were elderly (74.98 [SD, 8.12] years), with a mean left ventricular ejection fraction of 26.21% (SD, 9.77%), and 63.7% had class New York Heart Association III HF. Patients were followed up for 317 (SD, 96) days; 65.5% had FI threshold crossings (mean 1.45 [SD, 1.56] crossings), spending an average of 33.8 (SD, 42.4) days above FI threshold. Controlling for age, sex, left ventricular ejection fraction, functional class, and duration of follow-up, each additional point on the European Heart Failure Self-care Behaviour Scale was associated with an increase in the odds of having had an FI threshold crossing (adjusted odds ratio, 1.201; 95% confidence interval, 1.013-1.424; P<.05) and more days spent above FI threshold (incidence rate ratio, 1.051; 95% confidence interval, 1.002-1.102; P<.05).
Intrathoracic impedance measurements obtained from implantable devices provide important information regarding the influence of self-care on fluid accumulation in patients with HF.
有效的自我护理被认为是心力衰竭（HF）管理的关键。然而，自我护理对 HF 恶化时的液体蓄积的影响尚不清楚。因此，我们检查了自我护理与因胸腔内阻抗（Z）降低而导致的 HF 恶化时的液体蓄积之间的关系。
从使用 OptiVol 启用设备（美敦力公司，明尼苏达州明尼阿波利斯）的 58 例 HF 患者中收集 Z 数据。HF 自我护理采用欧洲心力衰竭自我护理行为量表进行测量。回归模型用于描述 HF 自我护理对液体指数（FI）阈值跨越的可能性、阈值跨越的数量和超过阈值的天数的影响。
患者年龄较大（74.98 [SD，8.12] 岁），平均左心室射血分数为 26.21%（SD，9.77%），63.7%的患者为纽约心脏协会 III 级 HF。患者的随访时间为 317（SD，96）天；65.5%有 FI 阈值跨越（平均 1.45 [SD，1.56] 次跨越），平均有 33.8（SD，42.4）天超过 FI 阈值。在控制年龄、性别、左心室射血分数、功能分级和随访时间后，欧洲心力衰竭自我护理行为量表上每增加 1 分，FI 阈值跨越的可能性增加（调整后的优势比，1.201；95%置信区间，1.013-1.424；P<.05），超过 FI 阈值的天数也增加（发病率比，1.051；95%置信区间，1.002-1.102；P<.05）。
植入式设备获得的胸腔内阻抗测量值提供了有关自我护理对 HF 患者液体蓄积影响的重要信息。
