Department of Geriatric Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
Eur J Heart Fail. 2019 Nov;21(11):1434-1442. doi: 10.1002/ejhf.1559. Epub 2019 Aug 1.
To evaluate the abilities to perform essential tasks for heart failure (HF) self-management in elderly patients, and its influence on post-discharge prognosis.
Overall, 415 patients ≥70 years old hospitalized for HF were included and followed during 1 year. The ability to perform six specific tasks (use of a scale, weight registration, diuretic identification, knowledge of salted foods, oedema identification, and treatment adjustment) was tested and distributed on terciles (T) of performance. Correlation with the self-administered questionnaire European HF Self-care Behaviour Scale (EHFScBS) was evaluated. The independent influence of self-care on 1-year mortality and readmission risks was calculated by Cox proportional hazards regression analysis. Mean age was 80.1 years. On average, patients could perform 2.9 ± 1.6 of self-care tasks, and only 5.3% could perform the six tasks correctly. Patients with previous HF self-care education had slight better performance (3.2 ± 1.6 vs 2.8 ± 1.6, P < 0.02). A weak correlation was found between EHFScBS and number of tasks correctly performed (r = -0.135; P = 0.006). One-year mortality in T1, T2, and T3 patients was 33.0%, 20.7%, and 14.1%, respectively (P = 0.002). Multivariable analysis showed T2 and T3 groups having a lower adjusted mortality risk compared with T1 [hazard ratio (HR) 0.58; 95% confidence interval (CI) 0.32-1.03; and HR 0.40; 95% CI 0.21-0.77, respectively], without differences in readmissions.
Most elderly patients admitted for HF are unable to perform several essential tasks needed for HF self-care. Self-perception of care was poorly correlated with real ability, and poor self-care ability was associated with higher 1-year mortality risk.
评估老年心力衰竭（HF）患者执行心力衰竭自我管理基本任务的能力及其对出院后预后的影响。
共纳入 415 名年龄≥70 岁因 HF 住院的患者，并在 1 年内进行随访。测试并分配了 6 项特定任务（使用量表、体重登记、利尿剂识别、咸食知识、水肿识别和治疗调整）的执行能力，将其分为表现的三分位数（T）。评估与自我管理问卷欧洲心力衰竭自我护理行为量表（EHFScBS）的相关性。通过 Cox 比例风险回归分析计算自我护理对 1 年死亡率和再入院风险的独立影响。平均年龄为 80.1 岁。平均而言，患者可以执行 2.9±1.6 项自我护理任务，只有 5.3%的患者可以正确执行 6 项任务。有心力衰竭自我护理教育史的患者表现稍好（3.2±1.6 与 2.8±1.6，P<0.02）。EHFScBS 与正确执行任务数量之间存在微弱相关性（r=-0.135；P=0.006）。T1、T2 和 T3 患者的 1 年死亡率分别为 33.0%、20.7%和 14.1%（P=0.002）。多变量分析显示，与 T1 相比，T2 和 T3 组的调整后死亡率风险较低[风险比（HR）0.58；95%置信区间（CI）0.32-1.03；和 HR 0.40；95%CI 0.21-0.77]，再入院率没有差异。
大多数因 HF 住院的老年患者无法执行 HF 自我护理所需的几项基本任务。自我护理感知与实际能力相关性较差，自我护理能力差与 1 年死亡率风险增加相关。
