Versteeg H, Denollet J, Meine M, Pedersen S S
Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
Neth Heart J. 2016 Jan;24(1):18-24. doi: 10.1007/s12471-015-0775-5.
Patient-reported factors have largely been neglected in search of predictors of response to cardiac resynchronisation therapy (CRT). The current study aimed to examine the independent value of pre-implantation patient-reported health status in predicting four-year survival and cardiac-related hospitalisation of CRT patients.
Consecutive patients (N = 139) indicated to receive a first-time CRT-defibrillator at the University Medical Center Utrecht were asked to complete a set of questionnaires prior to implantation. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess heart failure-specific health status. Data on patients' demographic, clinical and psychological characteristics at baseline, and on cardiac-related hospitalisations and all-cause deaths during a median follow-up of 3.9 years were obtained from purpose-designed questionnaires and patients' medical records.
Results of multivariable Cox regression analyses showed that poor patient-reported health status (KCCQ score < 50) prior to implantation was associated with a 2.5-fold increased risk of cardiac hospitalisation or all-cause death, independent of sociodemographic, clinical and psychological risk factors (adjusted hazard ratio 2.46, 95 % confidence interval (CI) 1.30-4.65). Poor health status was not significantly associated with the absolute number of cardiac-related hospital admissions, but with the total number of days spent in hospital during follow-up (adjusted incidence rate ratio 3.20, 95 % CI 1.88-5.44).
Patient-reported health status assessed prior to CRT identifies patients at risk for poor survival and prolonged hospital stays, independent of traditional risk factors. These results emphasise the importance of incorporating health status measures in cardiovascular research and patient management. Heart failure patients reporting poor health status should be identified and offered appropriate additional treatment programs.
在寻找心脏再同步治疗（CRT）反应的预测因素时，患者报告的因素在很大程度上被忽视了。本研究旨在探讨植入前患者报告的健康状况对CRT患者四年生存率和心脏相关住院治疗的预测独立价值。
在乌得勒支大学医学中心连续入选的139例首次接受CRT除颤器治疗的患者，在植入前被要求完成一系列问卷。堪萨斯城心肌病问卷（KCCQ）用于评估心力衰竭特异性健康状况。从专门设计的问卷和患者病历中获取患者基线时的人口统计学、临床和心理特征数据，以及在中位随访3.9年期间的心脏相关住院治疗和全因死亡数据。
多变量Cox回归分析结果显示，植入前患者报告的健康状况较差（KCCQ评分<50）与心脏住院或全因死亡风险增加2.5倍相关，独立于社会人口统计学、临床和心理风险因素（调整后风险比2.46，95%置信区间（CI）1.30-4.65）。健康状况较差与心脏相关住院绝对次数无显著关联，但与随访期间住院总天数相关（调整后发病率比3.20，95%CI 1.88-5.44）。
CRT植入前评估的患者报告健康状况可识别出生存不良和住院时间延长风险的患者，独立于传统风险因素。这些结果强调了在心血管研究和患者管理中纳入健康状况测量的重要性。应识别出报告健康状况较差的心力衰竭患者，并为其提供适当的额外治疗方案。
