Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Department of Primary Medical Care, University of Luebeck, Luebeck, Germany.
BMC Fam Pract. 2021 Oct 13;22(1):202. doi: 10.1186/s12875-021-01554-1.
The implementation of care concepts fitting the needs of patients with chronic heart failure (HF) remains challenging. In this context, psycho-emotional well-being is not routinely assessed, and under-researched despite indications that it is of great relevance for, e.g., acceptance, adherence, and prognosis. The aim of this study was to observe clinical characteristics for their prognostic utility in HF patients, and to compare the patients' health-related quality of life (QoL) with German population norm values.
The current post-hoc analysis was performed on data collected amongst participants of the RECODE-HF study who had fully answered the EQ-5D-5L™ items at both baseline and 12 months (n = 2354). The status in the patients' self-assessment items, EQ-5D visual analog scale (VAS) and EQ-5D index was categorized into worse/unchanged/improved. General linear mixed models (GLMM) with logit link were applied. Subgroups included 630 patients (26.8%) screened positive and 1724 patients (73.2%) screened negative for psychosocial distress (PSD).
The 12-months change in EQ-5D index, generally resulting from change in individual EQ-5D items, additionally associated not only with high NYHA class but sociodemographics (employment/living alone/GP practice years) (96.2% correctly classified in GLMM). The 12- months change in individual QoL aspects showed associations with age*NYHA, gender, body-mass index, and comorbidities dyslipidemia, myocardial infarction, asthma/chronic pulmonary disease. Important social roles were reflected in particular when HF patients lived alone or the doctor mentioned to the patient that the patient had HF. Patients with/without PSD differed in some sociodemographic and clinical parameters. However, no influence of PSD could be demonstrated in the 12-month follow-up of the EQ-5D-5L™. Nonetheless, comparison of the 12-months QoL with general German population norm values by age groups < 75 years and 75+ showed markedly health restrictions in HF patients in all EQ-5D-5L™ aspects.
Our analysis revealed different prognostic factors primarily associated with change of burden in different QoL aspects in HF patients. In GP practice it is important to consider in addition to the overall day-related VAS all the individual health-related QoL aspects to take a holistic view of the patient, as well as to pay particular attention to the interrelation of individual characteristics.
实施符合慢性心力衰竭（HF）患者需求的护理理念仍然具有挑战性。在这种情况下，心理情绪健康状况并未得到常规评估，尽管有研究表明其对患者的接受度、依从性和预后具有重要意义，但仍缺乏研究。本研究旨在观察临床特征对 HF 患者预后的预测价值，并将患者的健康相关生活质量（QoL）与德国人群的正常值进行比较。
本研究为 RECODE-HF 研究中参与者的事后分析，这些参与者在基线和 12 个月时均完整回答了 EQ-5D-5L™项目（n=2354）。患者自我评估项目、EQ-5D 视觉模拟量表（VAS）和 EQ-5D 指数的状态分为变差/不变/改善。采用对数链接的广义线性混合模型（GLMM）进行分析。亚组包括 630 名（26.8%）筛查阳性和 1724 名（73.2%）筛查阴性的心理社会困扰（PSD）患者。
EQ-5D 指数的 12 个月变化通常源自单个 EQ-5D 项目的变化，除了与较高的纽约心脏病协会（NYHA）心功能分级相关外，还与社会人口统计学因素（就业/独居/全科医生行医年限）相关（GLMM 中 96.2%的患者得到正确分类）。个体 QoL 方面的 12 个月变化与年龄*NYHA、性别、体重指数和合并症（血脂异常、心肌梗死、哮喘/慢性肺部疾病）相关。HF 患者独居或医生告知患者存在 HF 时，尤其能反映出重要的社会角色。有/无 PSD 的患者在一些社会人口统计学和临床参数方面存在差异。然而，在 EQ-5D-5L™的 12 个月随访中，PSD 并未显示出影响。尽管如此，通过与年龄组<75 岁和 75 岁以上的德国一般人群正常值进行比较，HF 患者在所有 EQ-5D-5L™方面的 12 个月 QoL 均显示出明显的健康限制。
我们的分析揭示了不同的预后因素，这些因素主要与 HF 患者不同 QoL 方面的负担变化相关。在全科医生的实践中，除了考虑到整体日常 VAS，还应考虑到所有个体健康相关的 QoL 方面，从整体上了解患者，特别注意个体特征的相互关系，这一点很重要。
