Caterina Checa, MSc, RN PhD Student, Primary Healthcare University Research Institute IDIAP-JordiGol; and Primary Healthcare Centre Dreta de l'Eixample, Barcelona; and Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, Bellaterra, Spain. Rosa Abellana, PhD Statistician, Primary Healthcare University Research Institute IDIAP-JordiGol, Barcelona, Spain. Jose-Maria Verdú-Rotellar, MD, PhD Senior Researcher, Primary Healthcare University Research Institute IDIAP-JordiGol, Barcelona; Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, Bellaterra; and Institut Català de la Salut, Barcelona, Spain. Anna Berenguera, PhD Senior Researcher, Primary Healthcare University Research Institute IDIAP-JordiGol, Barcelona; and Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, Bellaterra, Spain. Mar Domingo, MD, PhD Senior Researcher, Primary Healthcare University Research Institute IDIAP-JordiGol; and Institut Català de la Salut, Barcelona; and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Esther Calero, MSc, RN PhD Student, Primary Healthcare University Research Institute IDIAP-JordiGol; and Institut Català de la Salut, Barcelona, Spain. Miguel-Angel Muñoz Pérez, MD, PhD Senior Researcher, Primary Healthcare University Research Institute IDIAP-JordiGol, Barcelona; Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, Bellaterra; and Institut Català de la Salut, Barcelona, Spain.
J Cardiovasc Nurs. 2019 Jan/Feb;34(1):E8-E15. doi: 10.1097/JCN.0000000000000538.
Heart failure (HF) is a chronic condition that usually leads to death a few years after diagnosis. Although several clinical factors have been found to be related to increased mortality, less is known about the impact of social context, especially at the end stage of the disease. Knowing about social context is important to properly classify risk and provide holistic management for patients with advanced HF.
The aim of this study was to determine the impact of social context on mortality in patients with advanced HF.
A retrospective cohort study was conducted using data from clinical records on community-dwelling patients with HF and with New York Heart Association IV functional class living in Catalonia in northeastern Spain. Clinical data, patient dependency for basic activities of daily living, and social assessments were collected between 2010 and 2013. The primary outcome was all-cause mortality.
Data from 1148 New York Heart Association class IV patients were analyzed. Mean (SD) age was 82 (9.0) years, and 61.7% were women. The mean (SD) follow-up was 18.2 (11.9) months. Mortality occurred in 592 patients. Social risk was identified in 63.6% of the patients, and 9.3% acknowledged having social problems. In the adjusted multivariate model, being male (hazard ratio (HR), 1.82; 95% confidence interval [CI], 1.16-2.83), having high dependency on others for basic activities of daily living (HR, 2.16; 95% CI, 1.21-3.85), and presenting with a social problem (HR, 2.46; 95% CI, 1.22-4.97) were related to an increased risk of mortality.
An unfavorable social profile is an independent risk factor for mortality in patients with advanced HF.
心力衰竭（HF）是一种慢性疾病，通常在诊断后几年内导致死亡。尽管已经发现了一些与死亡率增加相关的临床因素，但对于社会背景的影响知之甚少，尤其是在疾病的晚期。了解社会背景对于正确分类风险并为晚期 HF 患者提供全面管理非常重要。
本研究旨在确定社会背景对晚期 HF 患者死亡率的影响。
使用来自临床记录的数据，对居住在西班牙东北部加泰罗尼亚的社区居住的 HF 患者和具有纽约心脏协会 IV 级功能分类的患者进行了回顾性队列研究。收集了 2010 年至 2013 年期间的临床数据、患者日常生活活动的基本活动能力依赖程度和社会评估。主要结局是全因死亡率。
对 1148 名纽约心脏协会 IV 级患者进行了数据分析。平均（SD）年龄为 82（9.0）岁，61.7%为女性。平均（SD）随访时间为 18.2（11.9）个月。592 名患者发生死亡。63.6%的患者存在社会风险，9.3%的患者承认存在社会问题。在调整后的多变量模型中，男性（危险比[HR]，1.82；95%置信区间[CI]，1.16-2.83）、对日常生活活动的基本活动能力高度依赖他人（HR，2.16；95%CI，1.21-3.85）和存在社会问题（HR，2.46；95%CI，1.22-4.97）与死亡率增加相关。
不良的社会状况是晚期 HF 患者死亡的独立危险因素。
