Bidwell Julie T, Vellone Ercole, Lyons Karen S, D'Agostino Fabio, Riegel Barbara, Paturzo Marco, Hiatt Shirin O, Alvaro Rosaria, Lee Christopher S
1 Oregon Health & Science University School of Nursing, Portland, OR, USA.
a Present institution/address: Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA.
Eur J Cardiovasc Nurs. 2017 Dec;16(8):707-714. doi: 10.1177/1474515117711305. Epub 2017 May 17.
Preventing hospitalization and improving event-free survival are primary goals of heart failure (HF) treatment according to current European Society of Cardiology guidelines; however, substantial uncertainty remains in our ability to predict risk and improve outcomes. Although caregivers often assist patients to manage their HF, little is known about their influence on clinical outcomes.
To quantify the influence of patient and caregiver characteristics on patient clinical event risk in HF.
This was a secondary analysis of data using a sample of Italian adults with HF and their informal caregivers ( n = 183 patient-caregiver dyads). HF patients were followed over 12 months for the following clinical events: hospitalization for HF, emergency room visit for HF or all-cause mortality. Influence of baseline caregiver- and patient-level factors (patient and caregiver age; dyad relationship type; patient New York Heart Association (NYHA) Class, cognition, and comorbidities; and caregiver strain, mental health status, and contributions to HF self-care) on patient risk of death or hospitalization/emergency room use was quantified using Cox proportional hazards regression.
Over the course of follow up, 32.8% of patients died, 19.7% were hospitalized for HF and 10.4% visited the emergency room. Higher caregiver strain, better caregiver mental health status and greater caregiver contributions to HF self-care maintenance were associated with significantly better event-free survival. Worse patient functional class and greater caregiver contributions to patient self-care management were associated with significantly worse patient event-free survival.
Considering caregiving factors together with patient factors significantly increases our understanding of patient clinical event risk in HF.
根据当前欧洲心脏病学会指南，预防住院和提高无事件生存率是心力衰竭（HF）治疗的主要目标；然而，我们预测风险和改善预后的能力仍存在很大不确定性。尽管护理人员经常协助患者管理心力衰竭，但对于他们对临床结局的影响知之甚少。
量化患者和护理人员特征对心力衰竭患者临床事件风险的影响。
这是一项对数据的二次分析，使用了意大利成年心力衰竭患者及其非正式护理人员的样本（n = 183对患者 - 护理人员）。对心力衰竭患者进行了12个月的随访，观察以下临床事件：因心力衰竭住院、因心力衰竭急诊就诊或全因死亡。使用Cox比例风险回归量化基线护理人员和患者层面因素（患者和护理人员年龄；二元关系类型；患者纽约心脏协会（NYHA）分级、认知和合并症；以及护理人员压力、心理健康状况和对心力衰竭自我护理的贡献）对患者死亡或住院/急诊使用风险的影响。
在随访过程中，32.8%的患者死亡，19.7%因心力衰竭住院，10.4%前往急诊室就诊。护理人员压力较高、心理健康状况较好以及对心力衰竭自我护理维持的贡献较大与显著更好的无事件生存率相关。患者功能分级较差以及护理人员对患者自我护理管理的贡献较大与患者无事件生存率显著较差相关。
将护理因素与患者因素一起考虑可显著增进我们对心力衰竭患者临床事件风险的理解。
