Kim Ha Mi, Kim JinShil, Hwang Seon Young
Heart Center, Chonnam National University Hospital, Gwangju, South Korea.
College of Nursing, Gachon University, Incheon, South Korea.
Asian Nurs Res (Korean Soc Nurs Sci). 2015 Mar;9(1):47-52. doi: 10.1016/j.anr.2014.11.004. Epub 2015 Feb 13.
Symptoms of postmyocardial infarction (post-MI) patients at risk for progression to heart failure are often ignored, and lack of symptom recognition or misinterpretation may diminish health-related quality of life (HRQoL). This study was conducted to evaluate the differences in HRQoL by symptom experience and determine factors that predict diminished HRQoL in post-MI patients.
Using a descriptive correlational study design, post-MI patients with left ventricular dysfunction (ejection fraction < 50%) completed face-to-face interviews for symptoms, HRQoL, covariates including self-care compliance, New York Heart Association class, and demographic and clinical questionnaires.
A total of 105 post-MI patients participated (mean age 65 years, 79.0% male, mean ejection fraction 43.6%, New York Heart Association class III/IV 33.3%). Mean length of time after the cardiac event was 48 months. Patients reported four or more symptoms, with fatigue being the most common symptom (63.8%), followed by shortness of breath (56.2%), weakness (54.3%), and dizziness (51.4%). HRQoL was moderately poor, with a mean score of 44.38 ± 27.66. There was no significant relationship between self-care compliance and HRQoL. Patients who were female, with low monthly income, and had lower functional capacity and more symptoms had worse HRQoL, after controlling for age and length of time after the event (adjusted R(2) = 0.53, p < .001).
A need for transitional care that assists post-MI patients take an active involvement in symptom monitoring arises so that they can get into the system earlier and benefit from treatment, and eventually achieve desirable HRQoL.
有进展为心力衰竭风险的心肌梗死后（心肌梗死后）患者的症状常常被忽视，缺乏症状识别或错误解读可能会降低健康相关生活质量（HRQoL）。本研究旨在评估症状体验对HRQoL的影响差异，并确定预测心肌梗死后患者HRQoL降低的因素。
采用描述性相关性研究设计，对左心室功能不全（射血分数<50%）的心肌梗死后患者进行面对面访谈，了解症状、HRQoL、包括自我护理依从性、纽约心脏协会分级在内的协变量以及人口统计学和临床问卷。
共有105名心肌梗死后患者参与研究（平均年龄65岁，79.0%为男性，平均射血分数43.6%，纽约心脏协会III/IV级33.3%）。心脏事件后的平均时间为48个月。患者报告有四种或更多症状，疲劳是最常见的症状（63.8%），其次是呼吸急促（56.2%）、虚弱（54.3%）和头晕（51.4%）。HRQoL中等程度较差，平均得分为44.38±27.66。自我护理依从性与HRQoL之间无显著关系。在控制年龄和事件后的时间长度后，女性、月收入低、功能能力较低且症状较多的患者HRQoL较差（调整后R(2)=0.53，p<.001）。
需要提供过渡性护理，以帮助心肌梗死后患者积极参与症状监测，以便他们能更早进入治疗体系并从治疗中获益，最终实现理想的HRQoL。
