射血分数保留的心力衰竭患者健康相关生活质量短期变化及其与2年死亡的相关性分析  

Association Between Short-term Changes in Health-related Quality of Life and Long-term Outcome in Acute Heart Failure Patients With Preserved Ejection Fraction

作　　者：蒲博轩 季润青 赫广达 霍西茜 彭越 张丽华 PU Boxuan;JI Runqing;HE Guangda;HUO Xiqian;PENG Yue;ZHANG Lihua(National Clinical Research Center for Cardiovascular Diseases,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院、北京协和医学院国家心血管病中心、阜外医院国家心血管疾病临床医学研究中心,北京100037

出　　处：《中国循环杂志》2023年第7期724-729,共6页Chinese Circulation Journal

基　　金：国家科技部国家重点研发计划(2018YFC1312400、2018YFC1312401);国家科技支撑计划(2015BAI12B02);中国医学科学院医学与健康科技创新工程(2021-I2M-1-007)。

摘　　要：目的:分析射血分数保留的心力衰竭(HFpEF)患者出院后1个月健康相关生活质量(HRQoL)较入院时的短期变化情况及其与2年死亡的相关性。方法:从重大慢病国家注册登记研究心力衰竭前瞻队列研究中选取2016年8月至2018年5月全国52家医院的1479例HFpEF患者。根据入院48 h内与出院后1个月时堪萨斯城心肌病问卷-12(KCCQ-12)评分变化值(ΔKCCQ)评估患者HRQoL,并依此将患者分为好转组(ΔKCCQ>5分)、稳定组(ΔKCCQ在-5~5分)、恶化组(ΔKCCQ<-5分),同时分析HRQoL短期变化情况与2年内全因死亡、心血管死亡的关系。结果:1479例急性HFpEF患者的中位年龄为71(63,79)岁,51.8%为女性;好转组1071例(72.4%),稳定组190例(12.8%),恶化组218例(14.7%)。出院后2年内,294(19.9%)例患者发生全因死亡,145(9.8%)例患者发生心血管死亡。多因素Cox回归模型分析显示,恶化组与稳定组2年内全因死亡风险分别是好转组的2.26倍(HR=2.26,95%CI:1.61~3.17,P<0.01)和1.78倍(HR=1.78,95%CI:1.25~2.55,P<0.01),2年内心血管死亡风险分别是好转组的2.99倍(HR=2.99,95%CI:1.86~4.81,P<0.01)和2.58倍(HR=2.58,95%CI:1.61~4.13,P<0.01)。此外,1个月随访时ΔKCCQ每增加5分,2年内全因死亡风险降低7%(HR=0.93,95%CI:0.91~0.96,P<0.01),心血管死亡风险降低9%(HR=0.91,95%CI:0.87~0.94,P<0.01)。结论:在急性HFpEF患者中,大部分患者出院后1个月HRQoL改善,仍有14.7%患者HRQoL变差,12.8%患者HRQoL未改善。HRQoL短期变化与长期死亡密切相关,HRQoL恶化和稳定的患者长期死亡风险显著高于好转患者。Objectives:To analyze the association between short-term changes(at 1-month after discharge versus admission)in health-related quality of life(HRQoL)and long-term outcome in patients hospitalized for acute heart failure with preserved ejection fraction(HFpEF).Methods:The China Patient-centered Evaluative Assessment of Cardiac Events(PEACE)-Prospective Heart Failure Study was a project,which prospectively enrolled patients hospitalized for acute heart failure in 52 hospitals nationwide from August 2016 to May 2018.HFpEF patients who completed the Kansas City Cardiomyopathy Questionnaire-12(KCCQ-12)within 48 hours of admission and at 1-month after discharge were included in this study.HFpEF patients were divided into the improved,stable,and worsening groups according to the KCCQ-12 change between the two time points.Data on deaths within 2-year after discharge was collected.We analyzed the association between short-term changes in HRQoL based on the KCCQ-12 assessment and death within 2 years after discharge in acute HFpEF patients.Results:The study included 1479 acute HFpEF patients.The median age was 71(63,79)years and 51.8%were women.There were 1071(72.4%)patients in the improved group,190(12.8%)in the stable group,and 218(14.7%)in the worsening group.Within 2-year after discharge,294(19.9%)patients died,including 145(9.8%)deaths due to cardiovascular reasons.Multifactorial Cox analysis showed that the risk of 2-year all-cause death in the worsening group and stable group were 2.26 times(HR=2.26,95%CI:1.61-3.17,P<0.01)and 1.78 times(HR=1.78,95%CI:1.25-2.55,P<0.01)higher than that in the improved group,and the risk of 2-year cardiovascular death were 2.99 times(HR=2.99,95%CI:1.86-4.81,P<0.01)and 2.58 times(HR=2.58,95%CI:1.61-4.13,P<0.01)higher than that in the improved group.In addition,HFpEF patients had a 7%(HR=0.93,95%CI:0.91-0.96,P<0.01)reduced risk of all-cause mortality and a 9%(HR=0.91,95%CI:0.87-0.94,P<0.01)reduced risk of cardiovascular death for every 5-point increase in KCCQ-12 change between 1-month a

关 键 词：射血分数保留的心力衰竭 健康相关生活质量 死亡 堪萨斯城心肌病问卷-12 

分 类 号：R54[医药卫生—心血管疾病]