Synergistic Effect of Disease Severity, Anxiety Symptoms and Elderly Age on the Quality of Life of Outpatients with Heart Failure

Abstract Background: Heart failure (HF) is a multifactorial syndrome with repercussions on quality of life (QoL). Objectives: To investigate the main interacting factors responsible to worsen quality of life of outpatients with HF. Methods: Cross-sectional observational study with 99 patients of both genders, attending a HF outpatient clinic at a university hospital, all with a reduced ejection fraction (<40%) by echocardiography. They were evaluated using sociodemographic and clinical questionnaires, the Minnesota Living with Heart Failure (MLwHF), and the Hospital Anxiety and Depression scale (HADS). QoL was the outcome variable. Two multivariate models were used: the parametric beta regression analysis, and the non-parametric regression tree, considering p < 0.05 and 0.05 < p < 0.10 for statistical and clinical significance, respectively. Results: Beta regression showed that depression and anxiety symptoms worsened the QoL of HF patients, as well as male sex, age younger than 60 years old, lower education level, lower monthly family income, recurrent hospitalizations and comorbidities such as ischemic heart diseases and arterial hypertension. The regression tree confirmed that NYHA functional class III and IV worsen all dimensions of MLwHF by interacting with anxiety symptoms, which influenced directly or indirectly the presence of poorer total score and emotional dimension of MLwHF. Previous hospitalization in the emotional dimension and age younger than 60 years in general dimension were associated with anxiety and NYHA functional class, also worsening the QoL of HF patients. Conclusion: HF with reduced ejection fraction was associated with poorer MLwHF. Anxiety symptoms, previous hospitalization and younger age were also associated with worsened MLwHF. Knowledge of these risk factors can therefore guide assessment and treatment of HF patients.

摘要
背景：心力衰竭（Heart Failure, HF）是一种多因素综合征，会对患者的生活质量（Quality of Life, QoL）产生不良影响。
研究目的：探究导致心力衰竭门诊患者生活质量恶化的主要交互影响因素。
研究方法：本研究为横断面观察性研究，纳入99名来自某大学医院心力衰竭门诊的男女患者，所有受试者经超声心动图检测证实射血分数降低（<40%）。研究采用社会人口学与临床问卷、明尼苏达心力衰竭生活质量量表（Minnesota Living with Heart Failure, MLwHF）以及医院焦虑抑郁量表（Hospital Anxiety and Depression Scale, HADS）进行评估。以生活质量作为结局变量，构建两种多变量模型：参数化β回归分析与非参数回归树模型；分别以p<0.05和0.05<p<0.10作为统计学显著性与临床显著性的判定标准。
研究结果：β回归分析显示，抑郁与焦虑症状、男性性别、年龄低于60岁、受教育程度较低、家庭月收入偏低、反复住院以及缺血性心脏病、动脉高血压等合并症，均会加重心力衰竭患者的生活质量恶化程度。回归树模型进一步证实，纽约心脏协会（New York Heart Association, NYHA）心功能分级Ⅲ、Ⅳ级与焦虑症状产生交互作用，可恶化明尼苏达心力衰竭生活质量量表的所有维度得分；该交互作用可直接或间接影响明尼苏达心力衰竭生活质量量表总分与情绪维度得分。在情绪维度中，既往住院史与年龄低于60岁（在总体维度中）分别与焦虑症状及NYHA心功能分级相关，同样会加重心力衰竭患者的生活质量恶化。
研究结论：射血分数降低型心力衰竭与较差的明尼苏达心力衰竭生活质量量表得分相关。焦虑症状、既往住院史与较年轻年龄同样与明尼苏达心力衰竭生活质量量表得分降低相关。明确上述危险因素，可为心力衰竭患者的评估与治疗提供指导方向。