Lokker Martine E, Gwyther Liz, Riley Jillian P, van Zuylen Lia, van der Heide Agnes, Harding Richard
Martine E. Lokker, RN, MSC PhD-student, Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands; Department of Palliative Medicine, University of Cape Town, Cape Town, South Africa. Liz Gwyther, MD Convener Palliative Medicine Programmes, Department of Palliative Medicine, University of Cape Town, Cape Town, South Africa. Jillian P. Riley, RN, PhD Honorary Lecturer, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom. Lia van Zuylen, MD, PhD Medical Oncologist, Department of Medical Oncology, Erasmus Medical Centre, Rotterdam, the Netherlands. Agnes van der Heide, MD, PhD Professor of Medical Care and Decision Making at the End of Life, Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands. Richard Harding, PhD Reader in Palliative Care, King's College London, Cicely Saunders Institute, London, United Kingdom.
J Cardiovasc Nurs. 2016 Jul-Aug;31(4):313-22. doi: 10.1097/JCN.0000000000000256.
Despite the high prevalence of heart failure in low- and middle-income countries, evidence concerning patient-reported burden of disease in advanced heart failure is lacking.
The aim of this study is to measure patient-reported symptom prevalence and correlates of symptom burden in patients with advanced heart failure.
Adult patients diagnosed with New York heart Association (NYHA) stage III or IV heart failure were recruited from the emergency unit, emergency ward, cardiology ward, general medicine wards, and outpatient cardiology clinic of a public hospital in South Africa. Patients were interviewed by researchers using the Memorial Symptom Assessment Scale-Short Form, a well-validated multidimensional instrument that assesses presence and distress of 32 symptoms.
A total of 230 patients (response, 99.1%), 90% NYHA III and 10% NYHA IV (12% newly diagnosed), with a mean age of 58 years, were included. Forty-five percent were women, 14% had completed high school, and 26% reported having no income. Mean Karnofsky Performance Status Score was 50%. Patients reported a mean of 19 symptoms. Physical symptoms with a high prevalence were shortness of breath (95.2%), feeling drowsy/tired (93.0%), and pain (91.3%). Psychological symptoms with a high prevalence were worrying (94.3%), feeling irritable (93.5%), and feeling sad (93.0%). Multivariate linear regression analyses, with total number of symptoms as dependent variable, showed no association between number of symptoms and gender, education, number of healthcare contacts in the last 3 months, years since diagnosis, or comorbidities. Increased number of symptoms was significantly associated with higher age (b = 0.054, P = .042), no income (b = -2.457, P = .013), and fewer hospitalizations in the last 12 months (b = -1.032, P = .017).
Patients with advanced heart failure attending a medical center in South Africa experience high prevalence of symptoms and report high levels of burden associated with these symptoms. Improved compliance with national and global treatment recommendations could contribute to reduced symptom burden. Healthcare professionals should consider incorporating palliative care into the care for these patients.
尽管低收入和中等收入国家心力衰竭的患病率很高，但关于晚期心力衰竭患者报告的疾病负担的证据却很缺乏。
本研究的目的是测量晚期心力衰竭患者报告的症状患病率以及症状负担的相关因素。
从南非一家公立医院的急诊科、急诊病房、心脏病病房、普通内科病房和门诊心脏病诊所招募被诊断为纽约心脏协会（NYHA）III或IV级心力衰竭的成年患者。研究人员使用纪念症状评估量表简表对患者进行访谈，这是一种经过充分验证的多维工具，用于评估32种症状的存在和困扰程度。
共纳入230例患者（应答率为99.1%），其中90%为NYHA III级，10%为NYHA IV级（12%为新诊断患者），平均年龄58岁。45%为女性，14%完成高中学业，26%报告无收入。平均卡诺夫斯基功能状态评分为50%。患者报告平均有19种症状。患病率较高的身体症状为呼吸急促（95.2%）、嗜睡/疲倦（93.0%）和疼痛（91.3%）。患病率较高的心理症状为担忧（94.3%）、易怒（93.5%）和悲伤（93.0%）。以症状总数为因变量的多变量线性回归分析显示，症状数量与性别、教育程度、过去3个月的医疗接触次数、诊断后的年数或合并症之间无关联。症状数量增加与年龄较大（b = 0.054，P = 0.042）、无收入（b = -2.457，P = 0.013）以及过去12个月住院次数较少（b = -1.032，P = 0.017）显著相关。
在南非一家医疗中心就诊的晚期心力衰竭患者症状患病率高，并报告与这些症状相关的负担水平高。更好地遵守国家和全球治疗建议可能有助于减轻症状负担。医疗保健专业人员应考虑将姑息治疗纳入对这些患者的护理中。
