J Cardiovasc Nurs. 2020 Mar/Apr;35(2):116-125. doi: 10.1097/JCN.0000000000000642.
In patients with heart failure (HF), good health-related quality of life (HRQOL) is as valuable as, or more valuable than, longer survival. However, HRQOL is remarkably poor, and HF symptoms are strongly associated with poor HRQOL. Yet, the multidimensional, modifiable predictors have been rarely examined.
The aim of this study was to examine the baseline psychosocial, behavioral, and physical predictors of HF symptoms and HRQOL at 12 months and the mediator effect of HF symptoms in the relationship between depressive symptoms and HRQOL.
We collected data from 94 patients with HF (mean ± SD age, 58 ± 14 years). Data included sample characteristics, depressive symptoms, perceived control, social support, New York Heart Association (NYHA) functional class, medication adherence, sodium intake, self-care management, and HF symptoms at baseline, as well as HF symptoms and HRQOL at 12 months. Multiple regression analyses were performed to address the purpose.
Baseline depressive symptoms (P < .001), medication adherence (P = .010), sodium intake (P = .032), and NYHA functional class (P = .040) significantly predicted 12-month HF symptoms, controlling for covariates (F = 7.363, R = 47%, P < .001). Baseline medication adherence (P = .001), NYHA functional class (P < .001), and HF symptoms (P = .013) significantly predicted 12-month HRQOL (F = 10.701, R = 59%, P < .001). Baseline HF symptoms fully mediated the relationship between baseline depressive symptoms and 12-month HRQOL.
Symptoms of HF and HRQOL could be improved by targeting multidimensional, modifiable predictors, such as self-care, depressive symptoms, and NYHA functional class.
在心力衰竭（HF）患者中，良好的健康相关生活质量（HRQOL）与生存时间一样有价值，甚至更有价值。然而，HF 患者的 HRQOL 却显著较差，HF 症状与较差的 HRQOL 密切相关。然而，多维的、可改变的预测因素很少被研究。
本研究旨在探讨 HF 症状和 12 个月时 HRQOL 的基线心理社会、行为和身体预测因素，以及抑郁症状与 HRQOL 之间的关系中 HF 症状的中介作用。
我们从 94 名 HF 患者中收集数据（平均年龄±标准差，58±14 岁）。数据包括样本特征、抑郁症状、感知控制、社会支持、纽约心脏协会（NYHA）功能分级、药物依从性、钠摄入量、自我护理管理以及基线时的 HF 症状，以及 12 个月时的 HF 症状和 HRQOL。采用多元回归分析来解决目的。
基线抑郁症状（P<0.001）、药物依从性（P=0.010）、钠摄入量（P=0.032）和 NYHA 功能分级（P=0.040）显著预测 12 个月时的 HF 症状，控制了协变量（F=7.363，R=47%，P<0.001）。基线药物依从性（P=0.001）、NYHA 功能分级（P<0.001）和 HF 症状（P=0.013）显著预测 12 个月时的 HRQOL（F=10.701，R=59%，P<0.001）。基线 HF 症状完全中介了基线抑郁症状与 12 个月 HRQOL 之间的关系。
通过针对自我护理、抑郁症状和 NYHA 功能分级等多维、可改变的预测因素，可以改善 HF 症状和 HRQOL。
