Additive prognostic value of subjective assessment with respect to clinical cardiological data in patients with chronic heart failure.

Giuseppina Majani, Antonia Pierobon, Gian Domenico Pinna, Anna Giardini, Roberto Maestri, Maria Teresa La Rovere
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引用次数: 2

Abstract

Background: Health-related quality of life tools that better reflect the unique subjective perception of heart failure (HF) are needed for patients with this disorder. The aim of this study was to explore whether subjective satisfaction of HF patients about daily life may provide additional prognostic information with respect to clinical cardiological data.

Methods: One hundred and seventy-eight patients (age 51 ± 9 years) with moderate to severe HF [New York Heart Association (NYHA) class 2.0 ± 0.7; left ventricular ejection fraction (LVEF) 29 ± 8%] in stable clinical condition underwent a standard clinical evaluation and compiled the Satisfaction Profile (SAT-P) questionnaire focusing on subjective satisfaction with daily life. Cox regression analysis was used to assess whether SAT-P factors (psychological functioning, physical functioning, work, sleep/eating/leisure, social functioning) had any prognostic value.

Results: Forty-six cardiac deaths occurred during a median of 30 months. Patients who died had higher NYHA class, more depressed left ventricular function, reduced systolic blood pressure (SBP), increased heart rate (HR), and worse biochemistry (all p < 0.05). Among the SAT-P factors, only physical functioning (PF) was significantly reduced in the patients who died (p = 0.003). Using the best subset selection procedure, resistance to physical fatigue (RPF) was selected from among the items of the PF factor. RPF showed independent predictive value when entered into a prognostic model including NYHA class, LVEF, SBP, and HR with an adjusted hazard ratio of 0.86 per 10 units increase (95% CI 0.75-0.98, p = 0.02).

Conclusions: Patients' dissatisfaction with physical functioning is associated with reduced long-term survival, after adjustment for known risk factors in HF. Given its user-friendly structure, simplicity, and significant prognostic value, the RPF score may represent a useful instrument in clinical practice.

慢性心力衰竭患者主观评价与临床心脏学资料的附加预后价值。
背景:与健康相关的生活质量工具能够更好地反映心力衰竭(HF)患者独特的主观感受。本研究的目的是探讨心衰患者对日常生活的主观满意度是否可以为临床心脏病学数据提供额外的预后信息。方法:178例中重度HF患者(年龄51±9岁)[纽约心脏协会(NYHA) 2.0±0.7级;左心室射血分数(LVEF)(29±8%)对患者进行标准的临床评价,并编制以日常生活主观满意度为重点的满意度问卷(SAT-P)。采用Cox回归分析评估SAT-P因素(心理功能、身体功能、工作、睡眠/饮食/休闲、社会功能)是否具有预后价值。结果:在平均30个月内发生46例心源性死亡。死亡的患者NYHA等级较高,左心室功能更低,收缩压(SBP)降低,心率(HR)升高,生化反应更差(均为p)。结论:在调整心衰已知危险因素后,患者对身体功能的不满意与长期生存率降低相关。考虑到其用户友好的结构、简单性和显著的预后价值,RPF评分在临床实践中可能是一个有用的工具。
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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