Zaharias Evanthia, Cataldo Janine, Mackin Lynda, Howie-Esquivel Jill
Department of Case Management, University of California, San Francisco Medical Center, 505 Parnassus Avenue, San Francisco, CA 94143-0208, USA.
Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, CA 94143-0610, USA.
Nurs Res Pract. 2014;2014:815984. doi: 10.1155/2014/815984. Epub 2014 Feb 9.
Background. Heart failure (HF) is a prevalent chronic condition where patients experience numerous uncomfortable symptoms, low functional status, and high mortality rates. Objective. To determine whether function and/or symptoms predict cardiac event-free survival in hospitalized HF patients within 90 days of hospital discharge. Methods. Inpatients (N = 32) had HF symptoms assessed with 4 yes/no questions. Function was determined with NYHA Classification, Katz Index of Activities of Daily Living (ADLs), and directly with the short physical performance battery (SPPB). Survival was analyzed with time to the first postdischarge cardiac event with events defined as cardiac rehospitalization, heart transplantation, or death. Results. Mean age was 58.2 ± 13.6 years. Patient reported ADL function was nearly independent (5.6 ± 1.1) while direct measure (SPPB) showed moderate functional limitation (6.4 ± 3.1). Within 90 days, 40.6% patients had a cardiac event. At discharge, each increase in NYHA Classification was associated with a 3.4-fold higher risk of cardiac events (95% CI 1.4-8.5). Patients reporting symptoms of dyspnea, fatigue, and orthopnea before discharge had a 4.0-fold, 9.7-fold, and 12.8-fold, respectively, greater risk of cardiac events (95% CI 1.2-13.2; 1.2-75.1; 1.7-99.7). Conclusions. Simple assessments of function and symptoms easily performed at discharge may predict short-term cardiac outcomes in hospitalized HF patients.
背景。心力衰竭（HF）是一种常见的慢性疾病，患者会经历多种不适症状、功能状态低下和高死亡率。目的。确定功能和/或症状是否能预测出院后90天内住院HF患者的无心脏事件生存期。方法。对32名住院患者用4个是/否问题评估HF症状。功能通过纽约心脏协会（NYHA）分级、卡茨日常生活活动能力指数（ADL）以及直接使用简短体能状况量表（SPPB）来确定。生存期分析为自出院后至首次发生心脏事件的时间，事件定义为再次住院、心脏移植或死亡。结果。平均年龄为58.2±13.6岁。患者报告的ADL功能接近独立（5.6±1.1），而直接测量（SPPB）显示有中度功能受限（6.4±3.1）。90天内，40.6%的患者发生了心脏事件。出院时，NYHA分级每增加一级，心脏事件风险升高3.4倍（95%可信区间1.4 - 8.5）。出院前报告有呼吸困难、疲劳和端坐呼吸症状的患者，心脏事件风险分别高4.0倍、9.7倍和12.8倍（95%可信区间1.2 - 13.2；1.2 - 第75.1页；1.7 - 99.7）。结论。出院时简单易行的功能和症状评估可能预测住院HF患者的短期心脏结局。 （注：原文中“1.2 - 第75.1页”可能有误，此处按原文翻译）
