Philips Research - Healthcare, Eindhoven, The Netherlands.
Department of Public Health, Centre for Medical Decision Making, Erasmus MC, Rotterdam, The Netherlands.
Eur J Heart Fail. 2018 Apr;20(4):689-696. doi: 10.1002/ejhf.1112. Epub 2018 Jan 4.
Psychosocial factors are rarely collected in studies investigating the prognosis of patients with heart failure (HF), and only time to first event is commonly reported. We investigated the prognostic value of psychosocial factors for predicting first or recurrent events after discharge following hospitalization for HF.
OPERA-HF is an observational study enrolling patients hospitalized for HF. In addition to clinical variables, psychosocial variables are recorded. Patients provide the information through questionnaires that include social information, depression and anxiety scores, and cognitive function. Kaplan-Meier, Cox regression and the Andersen-Gill model were used to identify predictors of first and recurrent events (readmissions or death). Of 671 patients (age 76 ± 15 years, 66% men) with 1-year follow-up, 291 had no subsequent event, 34 died without being readmitted, 346 had one or more unplanned readmissions, and 71 patients died after a first readmission. Increasing age, higher urea and creatinine, and the presence of co-morbidities (diabetes, history of myocardial infarction, chronic obstructive pulmonary disease) were all associated with increasing risk of first or recurrent events. Psychosocial variables independently associated with both the first and recurrent events were: presence of frailty, moderate-to-severe depression, and moderate-to-severe anxiety. Living alone and the presence of cognitive impairment were independently associated only with an increasing risk of recurrent events.
Psychosocial factors are strongly associated with unplanned recurrent readmissions or mortality following an admission to hospital for HF. Further research is needed to show whether recognition of these factors and support tailored to individual patients' needs will improve outcomes.
在研究心力衰竭（HF）患者预后的研究中，很少收集心理社会因素，并且通常仅报告首次事件的时间。我们调查了心理社会因素对预测 HF 住院后首次或复发性事件的预后价值。
OPERA-HF 是一项观察性研究，纳入了因 HF 住院的患者。除了临床变量外，还记录了心理社会变量。患者通过问卷提供信息，其中包括社会信息、抑郁和焦虑评分以及认知功能。使用 Kaplan-Meier、Cox 回归和 Andersen-Gill 模型来识别首次和复发性事件（再入院或死亡）的预测因素。在 671 例（年龄 76±15 岁，66%为男性）具有 1 年随访的患者中，291 例无后续事件，34 例死亡但未再入院，346 例有 1 次或多次计划外再入院，71 例首次再入院后死亡。年龄增长、尿素和肌酐升高以及合并症（糖尿病、心肌梗死史、慢性阻塞性肺疾病）的存在均与首次或复发性事件的风险增加相关。与首次和复发性事件独立相关的心理社会变量是：虚弱、中重度抑郁和中重度焦虑的存在。独居和认知障碍的存在仅与复发性事件风险增加独立相关。
心理社会因素与 HF 住院后计划外再入院或死亡密切相关。需要进一步研究以表明识别这些因素并为患者提供个性化需求的支持是否会改善预后。
