慢性心不全患者のための疾患特異 Development of Measure …

1 4 : 155 164. J Cardiol 2003 Oct; 42. Development of Measure for QOL Disease-Specific Quality of Life in Patients With Chronic Heart Failure Masachika TAMURA, MD. Kazuto OMIYA, MD. 1. Sumio YAMADA, PT 1. 2 Koichiro OKA, PhD 2. Noriyuki SUZUKI, MD. Naohiko OSADA, MD. Fumihiko MIYAKE, MD, Abstract . Objectives. To develop a Measure for disease-specific health-related quality of life in patients with heart failure and examine its reliability and validity. Methods. One hundred and four patients with stable chronic heart failure 74 males, 30 females, mean age years with left ventricular ejection fractions of less than 40% were enrolled in this study. Each patient responded to the Medical Outcomes Study Short Form 36 SF-36 and a disease specific ques- tionnaire comprising four categories dyspnea, sleep, appetite and fatigue , each consisting of five to six questions.

2 A stepwise exploratory factor analysis was applied to the disease-specific Measure to consider categorical fitness. In 25 of the 104 patients, the data in the questionnaire were compared with peak oxygen uptake, anaerobic threshold, slope of the regression line relating the ventilatory equivalent to carbon diox- ide output VE/ VCO2 slope and peak work rate. Correlations between the questionnaire and eight compo- nents of SF-36 were evaluated. Results. The appetite category proved unreliable and was excluded from consideration, so 12 questions were adopted from the other three categories. Cronbach' s values ranged from to and the coef- ficients of test-retest were from to , so both internal consistency and reproducibility of these ques- tions were considered excellent. The scores of three categories well reflected the severity of heart failure based in New York Heart Association functional class.

3 The anaerobic threshold r , peak oxygen uptake r , VE/ VCO2 slope r and peak work rate r correlated with the total score of the 12 questions. The total scores were closely correlated with the eight components of SF-36. Conclusions. This study suggests that the disease-specific questionnaire is applicable to evaluation of the health-related quality of life in patients with heart failure. 4 . J Cardiol 2003 Oct ; 42 : 155 164. Key Words Heart failure chronic Quality of life disease-specific Exercise tests .. quality of life : QOL .. : 216 8511 2 16 1 ; 1 ; 2 .. Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki ; 1 School of Health Sciences, Nagoya University, School of Medicine, Nagoya ; 2 Exercise Sciences Research Group, Tokyo Metropolitan Institute of Gerontology, Tokyo Address for correspondence : TAMURA M, MD, Division of Cardiology, Department of Internal Medicine, St.

4 Marianna University School of Medicine, Sugao 2 16 1, Miyamae-ku, Kawasaki 216 8511. Manuscript received April 14, 2003 ; revised June 23, 2003 ; accepted June 24, 2003. PT physical therapist 155. 156 . health-related QOL 1 Table 1 Clinical characteristics of the patients Age yr, mean SD Male/female 74/30. Etiology of heart failure Dilated cardiomyopathy 38. QOL . Previous myocardial infarction 27. 2 . Valvular heart diseases 16. QOL Hypertensive heart disease 10. Sickness Impact Profile 3 Nottingham Hypertrophic cardiomyopathy 8. 4 . Health Profile Medical Outcomes Study Short Form 36 Congenital heart diseases 3. 5 Atrial fibrillation 2. SF-36 . Medication Diuretics 101. Digitalis 29. Beta-blocker 28. ACEI or ARB 93.. Minnesota Living with Heart ACEI angiotensin converting enzyme inhibitor ; ARB.

5 Angiotensin receptor blocker. Failure Questionnaire6 Quality of Life in Severe Heart Failure Questionnaire 7 Chronic Heart Failure Ques- tionnaire8 Left Ventricular Dysfunction Questionnaire9 340 .. 2 . 1 QOL .. 4 .. QOL QOL . QOL Minnesota Living with Heart Failure Questionnaire6 . 21 13 . 4 .. 1 . 6 9 . 104 74 . 30 . 40% .. 3 5 . 6 21 . Fig. 1 . 38 27 16 1 . 10 8 . 3 2 . Table 1 4 . 4 : 155 164. J Cardiol 2003 Oct; 42. 157.. 0 100 .. SF-36 .. 11 12,13 . QOL .. 3 New York Heart Association . QOL .. New York Heart Association NYHA . QOL .. 4 . 25 . 22 3 15 . 7 2 1 . QOL .. Lode . CORIVAL 400 ramp . 3 0 . 20 W 3 6 . Fig. 1 Initial 21 questions of the disease-specific ques- 1 W . tionnaire original version in Japanese . ML- 5000 12 . 3 2 1 0 ST-T . 0 STBP-780 1 . 1 2 . 3 100 14.

6 QOL . leveling off . SF- . 36 breath by breath . AE-300S .. 2 Medical Outcomes Study Short Form 36 . QOL . QOL . 10 . SF-36 36 . 8 . VE/ . VCO slope . 2. 4 : 155 164. J Cardiol 2003 Oct; 42. 158 . Table 2 Results of factor analysis Factor loadings Items h2.. Dyspnea Walking with other person Going up stairs from 1st to 3rd floor Walking with light baggage Making bed or drying laundry Fatigue Feel sleepy at daytime Lack of concentration Tired out after going outside Feel dizzy on standing Sleep Wake up by dyspnea Feel fatigue when getting up Have nightmares Can sleep well % . Contribution ratio % . Cumulative contribution ratio Factor correlation Factor correlation 2. reversal item. h : Index of communality. x y . 15 . V-slope . V-slope . 17 .. 3 . 2 . 5% . Pearson NYHA . Cronbach.

7 P . Table 2 3 12 . 2. 33 p . 1 QOL . QOL . 16 . 2 5 Table 2 .. 3 .. 4 : 155 164. J Cardiol 2003 Oct; 42. 159. Table 3 Reliability of the questionnaire Test-retest Subscale Mean SD Cronbach'. s correlation Ceiling effect Floor effect coefficient % % . Dyspnea Fatigue Sleep 0. Total 0. Table 4 Correlations between the questionnaire and the components of Medical Outcomes Study Short Form 36. Dyspnea r Fatigue r r . Sleep Total r . Physical functioning Role-physical Bodily pain General health Vitality Social functioning Role-emotional Mental health 2 QOL 3 QOL . 1 Medical Outcomes Study Short Form 36 . QOL SF-36 . Cronbach 8 Table 4 . 1 . Table 3 SF-36 . 10 r . 2 2 NYHA . NYHA 39 . Table 3 55 10 . r QOL NYHA . r .. QOL QOL . 4 . Fig. 2 . 5,9 . 0 100 3 . Table 3 4 QOL . 0 Table 5.

8 100 . 20% . VE/ . VCO slope 2. 4 : 155 164. J Cardiol 2003 Oct; 42. 160 . Fig. 2 Comparison of health-related quality of life scores between NYHA classifications Each score and the total score worsened with severity of heart failure. NYHA New York Heart Association. Table 5 Correlations between the questionnaire and cardiopulmonary exercise test parameters Dyspnea r Fatigue r r . Sleep Total r . Anaerobic threshold Peak . VO 2 Peak work rate VE/ . VCO slope 2. VO2 oxygen uptake ; . VE/ . VCO2 slope slope of the regression line relating the ventilatory equivalent to carbon dioxide output.. 3 .. VE/ . VCO slope 2 . Fig. 3 .. 4 . 1 QOL SF-36 NYHA .. QOL . 17 . 4 : 155 164. J Cardiol 2003 Oct; 42. 161. Fig. 3 Correlations between the total score of the questionnaire and cardiopulmonary testing para- meters AT anaerobic threshold ; WR work rate.

9 Other abbreviations as in Table 5.. 1 . 3 12 .. SF-36 36. 1 .. 3 19 . QOL . 20 . SF-36 . QOL . 18 . 21 . 4 : 155 164. J Cardiol 2003 Oct; 42. 162 .. 104 . QOL 25 . SF-36 .. NYHA .. QOL . NYHA .. QOL .. QOL . 6 9 .. QOL . 24 26 . Minnesota Living with Heart Failure . 6 . Questionnaire Left Ventricular Dysfunction QOL 24,25 . Questionnaire9 26 . 25,26 . QOL . QOL .. VE/ . VCO slope . 2 .. 22 .. Minnesota Living with Heart . Failure Questionnaire r Left Ventricular . Dysfunction Questionnaire r . r ; . QOL . Table 5 .. 3 12 . QOL . 2 QOL . SF-36 .. 23 . VE/ . VCO slope . 2 QOL . 4 : 155 164. J Cardiol 2003 Oct; 42. 163.. A 13301006 .. : QOL .. : 40% 104 . 74 30 .. Medical Outcomes Study Short Form 36. SF-36 . 104 25 .. VE/ . VCO slope SF-36 8 . 2.. : 3 12 . QOL Cronbach . New York Heart Association.

10 12 r . r . VE/ . VCO slope r r . 2. SF-36 8 . : QOL.. 4 : 155 164. J Cardiol 2003 Oct; 42. instrument for clinical use. Scand J Psychol 1987 ; 28: 220 225. 1 : QOL : 8 Guyatt GH, Nogardi S, Halcrow S, Singer J, Sullivan MJ, in QOL Fallen EL : Development and testing of a new Measure of health status for clinical trials in heart failure. J Gen Intern 1 2001 ; pp 2 7 Med 1989 ; 4 : 101 107. 2 Stewart AL, Greenfield S, Hays RD, Wells K, Rogers WH, 9 O' Leary CJ, Jones PW : The left ventricular dysfunction Berry SD, McGlynn EA, Ware JE Jr : Functional status and questionnaire LVD-36 : Reliability, validity, and respon- well-being of patients with chronic conditions : Results siveness. Heart 2000 ; 83 : 634 640. from the Medical Outcomes Study. JAMA 1989 ; 262 : 10 : SF-36. 907 913.