心力衰竭患者总体感知健康的预测因素。
Predictors of overall perceived health in patients with heart failure.
机构信息
School of Nursing, San Diego State University, California 92021, USA.
出版信息
J Cardiovasc Nurs. 2013 May-Jun;28(3):206-15. doi: 10.1097/JCN.0b013e31824987a8.
BACKGROUND
Overall perceived health (OPH) is a powerful and independent predictor of negative health outcomes and low health-related quality of life. Overall perceived health is conspicuously low in patients with heart failure (HF).
OBJECTIVE
The purpose of this study was to determine the key predictors of OPH in persons with HF and explore possible mediating relationships.
METHODS
This cross-sectional predictive correlational study was a secondary analysis of an existing data set. Individual characteristics, biophysiological variables, physical symptoms, psychological symptoms, and physical and social functioning were identified from the Wilson and Cleary Model and tested as predictors of OPH in a 5-step hierarchical regression analysis.
RESULTS
The sample (n = 265) was primarily male (64.2%) and white (61.9%), with a mean age of 62 years, and had at least a high school education and a household income enough or more than enough to meet needs. Most (69.1%) had systolic dysfunction, and 78.5% were New York Heart Association class III or IV. The final model containing 15 predictors explained 39.2% of the variance in OPH. Six variables were significant independent predictors of OPH: perceived sufficiency of income, social functioning, comorbid burden, symptom stability, race, and the interaction of gender and social functioning, the last indicating social functioning as a stronger predictor for men than for women. In a multiple mediation analysis, the effects of shortness of breath and fatigue on OPH were mediated by physical and social functioning. Gender moderated the effect of fatigue through social functioning.
CONCLUSIONS
These variables explained a significant portion of the variance in OPH and can be used to target individuals at risk for low OPH and to tailor interventions. If OPH is low, a focus on patient symptoms and ability to participate in life activities is appropriate, with particular attention to social functioning in men.
背景
总体健康感知（OPH）是负面健康结果和低健康相关生活质量的强有力且独立的预测指标。心力衰竭（HF）患者的总体健康感知明显较低。
目的
本研究旨在确定 HF 患者 OPH 的主要预测因素，并探讨可能的中介关系。
方法
这是一项横断面预测相关性研究，是对现有数据集的二次分析。个体特征、生物生理变量、身体症状、心理症状以及身体和社会功能从 Wilson 和 Cleary 模型中确定，并在 5 步分层回归分析中作为 OPH 的预测因素进行测试。
结果
样本（n=265）主要为男性（64.2%）和白人（61.9%），平均年龄为 62 岁，至少受过高中教育，家庭收入足以或足以满足需求。大多数（69.1%）有收缩功能障碍，78.5%为纽约心脏协会 III 或 IV 级。包含 15 个预测因子的最终模型解释了 OPH 变异的 39.2%。六个变量是 OPH 的独立显著预测因子：收入感知充足、社会功能、共病负担、症状稳定性、种族以及性别和社会功能的相互作用，后者表明社会功能对男性的预测作用强于女性。在多重中介分析中，呼吸急促和疲劳对 OPH 的影响通过身体和社会功能进行中介。性别通过社会功能调节疲劳对 OPH 的影响。
结论
这些变量解释了 OPH 变异的很大一部分，可以用于针对 OPH 较低的个体，并针对干预措施进行调整。如果 OPH 较低，关注患者的症状和参与生活活动的能力是合适的，特别关注男性的社会功能。
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