Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Int J Cardiol. 2018 Sep 15;267:128-132. doi: 10.1016/j.ijcard.2018.04.102.
Heart failure with preserved ejection fraction (HFpEF) is associated with poor quality of life (QoL), or patient reported outcome (PRO). Despite female predominance in HFpEF, sex-specific differences in PROs remain poorly studied. We assessed PRO measures and their association with HF-severity and outcome in HFpEF by sex.
In 378 patients with HFpEF from the KaRen study, EQ-5D-3L® and Minnesota Living with Heart Failure Questionnaire® (MLHFQ) were assessed. Characteristics and comorbidities were largely similar in women (n = 212, 57%) and men. Women expressed worse QoL in EQ-5D-3L®(EQ-VAS), independent of age and HF-severity, mean (SD), 57 (20) vs. 61 (19), p = 0.010. There was no difference in MLHFQ, 31 (21) vs. 29 (21), p = 0.269. Spearman's correlations with HF-severity (NYHA-class) were for MLHFQ in women r 0.37 vs. men 0.41, p for both <0.001, and for EQ-VAS r -0.28, p = 0.001 vs. -0.45, p < 0.001. Correlations with natriuretic peptides were for MLHFQ r 0.21, p = 0.003 in women vs. men 0.27, p < 0.001, and for EQ-VAS r -0.17 vs. -0.27, p both < 0.001. Associations between PRO and the composite of HF hospitalisation or all-cause death were present in men only, adjusted HR per 5 units increase in MLHFQ 1.06, 95% confidence interval (CI) 1.01-1.11, p = 0.02 and EQ-VAS, HR 0.93, 95% CI 0.88-0.98, p = 0.010.
In HFpEF, women had worse general but similar disease specific QoL compared to men. QoL was more strongly associated with HF-severity in men, and associated with outcomes only in men. In women with HFpEF, QoL appears less determined by HF itself and potentially more by other unknown factors.
射血分数保留的心力衰竭（HFpEF）与生活质量（QoL）或患者报告的结果（PRO）较差相关。尽管心力衰竭中女性占主导地位，但 PRO 方面的性别差异仍研究甚少。我们评估了 PRO 测量及其与 HFpEF 中 HF 严重程度和结局的相关性。
在 KaRen 研究中的 378 名 HFpEF 患者中，评估了 EQ-5D-3L®和明尼苏达州心力衰竭生活质量问卷（MLHFQ）。女性（n=212，57%）和男性的特征和合并症基本相似。女性在 EQ-5D-3L®（EQ-VAS）中的 QoL 较差，独立于年龄和 HF 严重程度，平均（标准差）分别为 57（20）和 61（19），p=0.010。MLHFQ 无差异，分别为 31（21）和 29（21），p=0.269。Spearman 相关性与 HF 严重程度（NYHA 分级）在女性中为 MLHFQ r 0.37，男性为 0.41，两者均 <0.001，与 EQ-VAS 为 r -0.28，p=0.001 与 r -0.45，p<0.001。与利钠肽的相关性在女性中为 MLHFQ r 0.21，p=0.003，男性 r 0.27，p<0.001，与 EQ-VAS 为 r -0.17，p=0.001 与 r -0.27，p均<0.001。在男性中，PRO 与 HF 住院或全因死亡的复合终点之间存在相关性，MLHFQ 每增加 5 个单位，调整后的 HR 为 1.06，95%置信区间（CI）为 1.01-1.11，p=0.02，EQ-VAS 的 HR 为 0.93，95%CI 为 0.88-0.98，p=0.010。
在 HFpEF 中，女性的一般 QoL 较差，但疾病特异性 QoL 与男性相似。在男性中，QoL 与 HF 严重程度的相关性更强，而与结局的相关性仅在男性中存在。在 HFpEF 女性中，QoL 似乎较少由 HF 本身决定，而更多地由其他未知因素决定。
