NYHA classification deterioration and quality of life in heart failure inpatients: A chain mediation analysis of cognitive impairment and depression

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung Pub Date : 2025-05-09 DOI:10.1016/j.hrtlng.2025.04.033

Jin Yang , You Pu , Mingjun He , Tianyi Wang , Ting Ye , Yunman Huang , Yunfeng Di , Xianqin Zhang , Zheng Yang

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引用次数: 0

Abstract

Background

Health-related quality of life (HRQoL) is a key indicator of the prognosis of heart failure (HF) patients. Although the association between the New York Heart Association (NYHA) class and HRQoL has been widely recognized, the underlying mechanisms of this association have not been fully elucidated.

Objectives

This study aimed to investigate the mediating role of cognitive impairment and depressive symptoms in NYHA class and HRQoL in HF patients.

Methods

We used a convenience sampling method to select HF patients hospitalized between December 2023 and April 2024 in China. General information, NYHA class, cognitive function, depressive symptoms, and HRQoL were assessed. We conducted mediated effects analyses using the "Bruce" package in the R software.

Results

A total of 313 HF patients were included in this study. The HRQoL scores of the patients were 62.60 ± 13.94. NYHA class, cognitive impairment, and depressive symptoms were positively correlated with the HRQoL scores. Mediation effect analysis showed that the mediation effects of cognitive impairment, depressive symptoms, and the combination of the two between NYHA class and HRQoL were 0.059, 0.119, and 0.044, accounting for 9.08 %, 18.30 %, and 6.77 % of the total effect, respectively.

Conclusion

NYHA class in HF patients directly and indirectly impacts HRQoL through cognitive impairment and depressive symptoms. Healthcare providers should prioritize joint assessment of cognitive function and depression symptoms, implementing comprehensive interventions to mitigate NYHA class effects on HRQoL.

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心衰住院患者NYHA分级、恶化与生活质量：认知功能障碍与抑郁的连锁中介分析

健康相关生活质量（HRQoL）是心衰（HF）患者预后的关键指标。尽管纽约心脏协会（NYHA）分级与HRQoL之间的关联已被广泛认可，但这种关联的潜在机制尚未完全阐明。目的探讨认知障碍和抑郁症状在心衰患者NYHA分级和HRQoL中的中介作用。方法采用方便抽样方法，选取2023年12月至2024年4月在中国住院的HF患者。评估一般信息、NYHA分级、认知功能、抑郁症状和HRQoL。我们使用R软件中的“Bruce”包进行了中介效应分析。结果本研究共纳入313例HF患者。患者HRQoL评分为62.60±13.94分。NYHA分级、认知障碍、抑郁症状与HRQoL评分呈正相关。中介效应分析显示，NYHA分级与HRQoL之间认知障碍、抑郁症状及两者联合的中介效应分别为0.059、0.119、0.044，分别占总效应的9.08%、18.30%、6.77%。结论心衰患者nyha分级通过认知障碍和抑郁症状直接或间接影响HRQoL。医疗保健提供者应优先考虑认知功能和抑郁症状的联合评估，实施综合干预措施以减轻NYHA类对HRQoL的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart & Lung 医学-呼吸系统

CiteScore

4.60

自引率

3.60%

发文量

184

审稿时长

35 days

期刊介绍： Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders. The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.