| ObjectivesBased on the biopsychosocial holistic model of cardiovascular health,this study aimed to explore the biological,psychological,social factors associated with the quality of life and adverse cardiovascular events(including cardiovascular readmission and cardiovascular death)in chronic heart failure patients,thus developing interventions and improving their health outcomes.MethodsA total of 260 inpatients with chronic heart failure in a university hospital were recruited from December 2016 to May 2017.The patients filled out the questionnaires of general information questionnaire,12-item Short Form Health Survey,Baseline Dyspnea Index,Brief Fatigue Inventory,Perceived Stress Scale,The Hospital Anxiety and Depression Scale,Social Connectedness Scale,and Social Disability Screening Scale.The patients were followed up by telephone to complete the 12-item Short Form Health Survey and to acquire the patient’s cardiovascular readmission and cardiovascular death.SPSS 22.0 was used for statistical analysis.Results1.A total of 260 cases were obtained at baseline,the average scores for the quality of life were 50.09±8.47 for physical health and 49.87±9.65 for mental health.217 patients were contacted at the three-month follow-up after discharge,of which 57 had cardiovascular readmission and 8 had cardiovascular death,and the average scores for the quality of life among 209 survivors were 50.00±9.20 for physical health and 50.00±9.10 for mental health.2.Relationships between chronic heart failure patients’ general characteristics and quality of life(1)For quality of life at baseline,age was negatively correlated with score for physical health,and patients who were retired/unemployed,with disease duration>6 months,had NYHA III scored lower on physical health than those who engaged in physical labor or brainwork,with disease duration<6 months,had NYHA II(all P<0.01).Patients who were high school and below educated,had monthly incomes<1000 yuan scored lower on mental health than those who had college degree or above and monthly incomes ≥ 1000 yuan(P<0.05 or P<0.01).(2)For quality of life at three month after discharge,age was negatively correlated with score for physical health,and patients who were single(unmarried/divorced/widowed),retired/unemployed,with disease duration≥6 months scored lower on physical health than those who were married/cohabiting,engaged in physical labor or brainwork,with disease duration<6 months(P<0.05 or P<0.01).Patients who were junior middle school and below educated,engaged in physical labor or were retired/unemployed,with disease duration>6 months scored lower on mental health than those who had college degree or above,engaged in brainwork,with disease duration<6 months(P<0.05 or P<0.01).3.Relationships between chronic heart failure patients’ biological factors,psychological factors,social factors and quality of life(1)For quality of life at baseline,the score for dyspnea(5.66±2.77)was positively correlated with score for physical health(r=0.602,P<0.01),and the scores for fatigue(4.34±2.56)and social function(4.19±3.25)were negatively correlated with score for physical health(r=-0.409,-0.492,all P<0.01);the scores for dyspnea and social connectedness(4.18±0.61)were positively correlated with score for mental health(r=0.274,0.398,all P<0.01),and the scores for fatigue,perceived stress(14.79±6.04),anxiety(5.88±3.85),depression(4.60±4.03)and social function were negatively correlated with score for mental health(r=-0.402,-0.699,-0.569,-0.647,-0.399,all P<0.01).(2)For quality of life at three month after discharge,the score for dyspnea was positively correlated with score for physical health(r=0.360,P<0.01),and the scores for fatigue,depression and social function were negatively correlated with score for physical health(r=-0,266,-0.159,-0.492,P<0.05 or P<0.01);the scores for dyspnea and social connectedness were positively correlated with score for mental health(r=0.246,0.181,all P<0.01),and the scores for fatigue,perceived stress,anxiety,depression and social function were negatively correlated with score for mental health(r=-0.435,-0.503,-0.457,-0.481,-0.310,all P<0.01).4.Multiple regression of quality of life in chronic heart failure patientsFor quality of life at baseline,factors associated with physical health were retired/unemployed(physical labor as reference),disease duration>6 months(<6 months as reference),dyspnea and fatigue.These four variables explained 39.9%of the variance in baseline physical health.Factors associated with mental health were perceived stress,anxiety,depression and social connectedness.These four variables explained 59.4%of the variance in baseline mental health.5.Generalized estimating equation of quality of life in chronic heart failure patients(1)Retired/unemployed(physical labor as reference,B=-2.399),disease duration≥ 6 months(<6 months as reference,B=-2.635),dyspnea(B=1.164)and fatigue(B=-0.597)were the significant predictors of physical health of quality of life.(2)Disease duration>6 months(<6 months as reference,B=-2.004),perceived stress(B=-0.530),anxiety(B=-0.405)and depression(B=-0.518)were the significant predictors of mental health of quality of life.6.Factors related adverse cardiovascular events three months after discharge in patients with chronic heart failure(1)There were significant difference in age,employment status,NYHA,dyspnea,fatigue,depression,social function and PCS0 between the non-cardiovascular adverse events group and the cardiovascular adverse events group.(2)The results of logistic regression analysis showed that the risk factors for adverse cardiovascular events in patients with chronic heart failure after three months of discharge were retired/unemployed(physical labor as reference),NYHA IV(NYHA Ⅱ as reference),and fatigue.Conclusions1.The quality of life in patients with chronic heart failure needs to be further improved.The incidence of adverse cardiovascular events(cardiovascular readmission and cardiovascular death)is still at a high level.2.Factors influencing the physical health were employment status,disease duration,dyspnea and fatigue,and factors influencing the mental health were disease duration,perceived stress,anxiety and depression.3.Patients’ employment status,NYHA and fatigue were significant predictors of cardiovascular adverse events.4.The clinical staff can take the biological,psychological,social factors that affect the health outcomes of patients with chronic heart failure as entry points,and implement targeted and individualized interventions,so as to improve the patient’s quality of life and to reduce the rate of readmission and death. |
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