心衰患者心理健康、认知功能和自我护理行为的变化分析:一项前瞻性队列研究

IF 2.1 4区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL
Maria Jędrzejczyk, Christopher S Lee, Ercole Vellone, Anna Gozdzik, Remigiusz Szczepanowski, Michał Czapla, Izabella Uchmanowicz
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引用次数: 0

摘要

背景:心力衰竭(HF)是一种影响全世界数千万人的慢性疾病。尽管在治疗方面取得了进展,但其对心理健康、认知功能和自我保健行为的影响仍未得到充分探讨,特别是在射血分数表型方面,这强调了对这些相互关联的领域进行全面调查的必要性。目的:本前瞻性队列研究调查了6个月以上以射血分数(EF)表型分层的心衰患者情感症状、认知功能和自我护理行为的变化。材料和方法:本研究纳入162例60岁以上诊断为心衰的患者。参与者在入组时和6个月后接受了检查。采用简易精神状态检查(MMSE)、医院焦虑抑郁量表(HADS)、患者健康问卷-9 (PHQ-9)和欧洲心力衰竭自我护理行为量表(EHFScB-9)评估认知功能、情感症状和自我护理行为。结果:与保留型心衰(HFpEF)患者相比,轻度减轻型心衰(HFmrEF)患者的MMSE显示的认知功能障碍较轻(MMSE中位评分:28[四分位间距(IQR): 27-29]对27 [IQR: 25-28];P = 0.008)。HADS显示,抑郁严重程度在6个月内恶化,尤其是HFpEF组(中位评分从1 [IQR: 0-4]增加到3 [IQR: 0-6];P = 0.006)。所有组的自我照顾能力均下降,EHFSc-9(较差的自我照顾)中位数得分升高,从基线时的28 [IQR: 21-33]变为6个月时的29 [IQR: 23-34] (p = 0.035)。此外,HFrEF组NT-proBNP参数(3437.7 pg/mL [IQR: 1336.33-6226.43)高于HFmrEF和HFpEF组(分别为2171.2 pg/mL [IQR: 806.65-4033.15]和977.1 pg/mL [IQR: 576.9-3708.95, p = 0.001)。结论:HF患者在6个月内表现出明显的认知能力下降、抑郁症状增加和自我护理减少,其中HFpEF患者表现出最明显的损害。不同HF表型的结果差异突出了需要定制诊断和治疗策略来解决这一人群的认知和情感挑战。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Analysis of changes in mental health, cognitive function and self-care behaviors in patients with heart failure: A prospective cohort study.

Background: Heart failure (HF) is a chronic condition affecting tens of millions of people worldwide. Despite advances in treatment, its impact on mental health, cognitive function and self-care behaviors remains underexplored, particularly across ejection fraction phenotypes, underscoring the need for comprehensive investigations into these interconnected domains.

Objectives: This prospective cohort study investigated changes in affective symptoms, cognitive functioning and self-care behaviors in patients with HF stratified with ejection fraction (EF) phenotypes over 6 months.

Material and methods: The study included 162 patients aged over 60 years with a diagnosis of HF. Participants were examined at enrollment and after 6 months. The Mini-Mental State Examination (MMSE), the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9) and the European Heart Failure Self-care Behaviour Scale (EHFScB-9) were used to assess cognitive function, affective symptoms and self-care behaviors.

Results: Cognitive impairment indicated with the MMSE was less severe in patients with mildly-reduced HF (HFmrEF) compared to preserved EF (HFpEF) (MMSE median scores: 28 [interquartile range (IQR): 27-29] vs 27 [IQR: 25-28]; p = 0.008). The HADS showed that severity of depression worsened over 6 months, particularly in the HFpEF group (median scores increased from 1 [IQR: 0-4] to 3 [IQR: 0-6]; p = 0.006). Self-care ability declined in all groups as indicated in the increased EHFSc-9 (poorer self-care) median scores, which changed from 28 [IQR: 21-33] at baseline to 29 [IQR: 23-34] at 6 months (p = 0.035). Additionally, NT-proBNP parameters were higher in the HFrEF group (3437.7 pg/mL [IQR: 1336.33-6226.43) compared to both HFmrEF and HFpEF (2171.2 pg/mL [IQR: 806.65-4033.15] and 977.1 pg/mL [IQR: 576.9-3708.95, respectively, p = 0.001).

Conclusions: Patients with HF showed significant cognitive decline, increased depressive symptoms and reduced self-care over 6 months, with HFpEF patients exhibiting the most pronounced impairments. Differences in outcomes across HF phenotypes highlight the need for tailored diagnostic and therapeutic strategies to address cognitive and emotional challenges in this population.

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来源期刊
Advances in Clinical and Experimental Medicine
Advances in Clinical and Experimental Medicine MEDICINE, RESEARCH & EXPERIMENTAL-
CiteScore
3.70
自引率
4.80%
发文量
153
审稿时长
6-12 weeks
期刊介绍: Advances in Clinical and Experimental Medicine has been published by the Wroclaw Medical University since 1992. Establishing the medical journal was the idea of Prof. Bogumił Halawa, Chair of the Department of Cardiology, and was fully supported by the Rector of Wroclaw Medical University, Prof. Zbigniew Knapik. Prof. Halawa was also the first editor-in-chief, between 1992-1997. The journal, then entitled "Postępy Medycyny Klinicznej i Doświadczalnej", appeared quarterly. Prof. Leszek Paradowski was editor-in-chief from 1997-1999. In 1998 he initiated alterations in the profile and cover design of the journal which were accepted by the Editorial Board. The title was changed to Advances in Clinical and Experimental Medicine. Articles in English were welcomed. A number of outstanding representatives of medical science from Poland and abroad were invited to participate in the newly established International Editorial Staff. Prof. Antonina Harłozińska-Szmyrka was editor-in-chief in years 2000-2005, in years 2006-2007 once again prof. Leszek Paradowski and prof. Maria Podolak-Dawidziak was editor-in-chief in years 2008-2016. Since 2017 the editor-in chief is prof. Maciej Bagłaj. Since July 2005, original papers have been published only in English. Case reports are no longer accepted. The manuscripts are reviewed by two independent reviewers and a statistical reviewer, and English texts are proofread by a native speaker. The journal has been indexed in several databases: Scopus, Ulrich’sTM International Periodicals Directory, Index Copernicus and since 2007 in Thomson Reuters databases: Science Citation Index Expanded i Journal Citation Reports/Science Edition. In 2010 the journal obtained Impact Factor which is now 1.179 pts. Articles published in the journal are worth 15 points among Polish journals according to the Polish Committee for Scientific Research and 169.43 points according to the Index Copernicus. Since November 7, 2012, Advances in Clinical and Experimental Medicine has been indexed and included in National Library of Medicine’s MEDLINE database. English abstracts printed in the journal are included and searchable using PubMed http://www.ncbi.nlm.nih.gov/pubmed.
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