晚期心力衰竭患者生活质量和临床结局的性别差异：来自 PAL-HF 试验的见解。
Sex Differences in Quality of Life and Clinical Outcomes in Patients With Advanced Heart Failure: Insights From the PAL-HF Trial.
机构信息
Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (L.K.T., M.F., A.S., A.C., C.B.P., B.G., N.P., R.A., J.R., A.L., P.S.D., J.G.R., R.J.M.).
Inova Heart and Vascular Institute, Falls Church, VA (C.O.).
出版信息
Circ Heart Fail. 2020 Apr;13(4):e006134. doi: 10.1161/CIRCHEARTFAILURE.119.006134. Epub 2020 Apr 9.
BACKGROUND
Palliative care improves quality of life in patients with heart failure. Whether men and women with heart failure derive similar benefit from palliative care interventions remains unknown.
METHODS
In a secondary analysis of the PAL-HF trial (Palliative Care in Heart Failure), we analyzed differences in quality of life among men and women with heart failure and assessed for differential effects of the palliative care intervention by sex. Differences in clinical characteristics and quality-of-life metrics were compared between men and women at serial time points. The primary outcome was change in Kansas City Cardiomyopathy Questionnaire score between baseline and 24 weeks.
RESULTS
Among the 71 women and 79 men, there was a significant difference in baseline Kansas City Cardiomyopathy Questionnaire (24.5 versus 36.2, respectively; =0.04) but not Functional Assessment of Chronic Illness Therapy-Palliative Care scale (115.7 versus 120.3; =0.27) scores. Among those who received the palliative care intervention (33 women and 42 men), women's quality-of-life score remained lower than that of men after enrollment. Treated men's scores were significantly higher than those untreated (6-month Kansas City Cardiomyopathy Questionnaire, 68.0 [interquartile range, 52.6-85.7] versus 41.1[interquartile range, 32.0-78.3]; =0.047), whereas the difference between treated and untreated women was not significantly different (=0.39). Rates of death and rehospitalization, as well as the composite end point, were similar between treated and untreated women and men.
CONCLUSIONS
In the PAL-HF trial, women with heart failure experienced a greater symptom burden and poorer quality of life as compared with men. The change in treated men's Kansas City Cardiomyopathy Questionnaire score between baseline and 24 weeks was significantly higher than those untreated; this trend was not observed in women. Thus, there may be a sex disparity in response to palliative care intervention, suggesting that sex-specific approaches to palliative care may be needed to improve outcomes. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT0158960.
背景
姑息治疗可改善心力衰竭患者的生活质量。但尚不清楚心力衰竭患者是否能从姑息治疗干预中获得相似的益处。
方法
在姑息治疗心力衰竭试验（PAL-HF 试验）的二次分析中，我们分析了心力衰竭男性和女性患者生活质量的差异，并评估了姑息治疗干预对男性和女性的不同影响。比较了男性和女性在各时间点的临床特征和生活质量指标的差异。主要结局是基线至 24 周时堪萨斯城心肌病问卷评分的变化。
结果
在 71 名女性和 79 名男性中，基线时堪萨斯城心肌病问卷评分存在显著差异（分别为 24.5 和 36.2，=0.04），但慢性疾病治疗功能评估-姑息治疗量表评分无显著差异（分别为 115.7 和 120.3，=0.27）。在接受姑息治疗干预的患者中（33 名女性和 42 名男性），入组后女性的生活质量评分仍低于男性。治疗组男性的评分显著高于未治疗组（6 个月时堪萨斯城心肌病问卷评分，68.0[四分位距，52.6-85.7]比 41.1[四分位距，32.0-78.3]；=0.047），而治疗组和未治疗组女性之间的差异无统计学意义（=0.39）。治疗组和未治疗组女性和男性的死亡率、再住院率和复合终点发生率相似。
结论
在 PAL-HF 试验中，与男性相比，心力衰竭女性患者的症状负担更重，生活质量更差。与未治疗组相比，治疗组男性基线至 24 周时堪萨斯城心肌病问卷评分的变化显著更高；而女性则没有这种趋势。因此，姑息治疗干预的反应可能存在性别差异，这表明可能需要针对姑息治疗的性别特定方法来改善结局。
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