外来通院する収縮機能障害患者のhealth related quality of life(新潟・佐渡心不全研究 第2報)

Health-related Quality of Life in Outpatients with Systolic Dysfunction：Second report of Niigata-Sado Heart Failure Study

要旨

　【目的】　外来通院により治療を受けている左室収縮機能障害(SD)患者の健康関連QOL(health related quality of life；HRQOL)について検討した．

　【方法】　佐渡市の医療機関で1998年1月から2002年12月に行われた連続7,000件の心エコー検査より，SDがある60～84歳の外来通院患者を全て抽出した．これらの患者の診療録を調査し，Medical Outcome Study Short Form36を含む質問票を郵送し回答を得た．

　【結果】　5年間で446名のSD患者が抽出された．2004年末に生存した322名へ質問票を送付し，215名(男性146名)から回答を得た．患者は平均4.6年の外来治療を受けており，男女とも身体機能，全体的健康感，心の健康が国民標準値と比し低下していた．これらの下位尺度の低下は運動耐容能の低下と有意に相関した．

　【結語】　外来治療中のSD患者は心身両面のHRQOLが低下していた．HRQOLの低下は運動耐容能の低下と相関し，その改善を目標とした治療によりQOLの改善が期待される．

　Purpose: Quality of life(QOL) in patients with systolic dysfunction(SD) is uncertain in Japan. We investigated outpatients with SD in Sado City to quantify QOL and identify the correlation between QOL and clinical characteristics.

　Methods: Outpatients with SD ［ejection fraction(EF) 50% or less］ aged 60 to 84 were enrolled. Patients completed questionnaires which included a 36-Item Short-Form Health Survey(SF-36) and Specific Activity Scale(SAS). Clinical information was collected from medical records.

　Results: We diagnosed 446 patients as SD during the past 5 years. A total of 322 patients were survived in 2004, and 215 patients(66.8%) completed the questionnaire. They showed NYHA 2.4±0.9(Mean±SD), SAS 4.7±1.8 METs, and EF 40.8±8.6%. Patients with SD had low scores in all QOL domains except bodily pain. Especially, physical functioning and general health were significantly lower than that of healthy controls(p＜0.05). Elderly women had multiple impairments in both physical and mental domains. These QOL points were significantly correlated with SAS and NYHA, but not echocardiographic indicators, etiology, clinical history.

　Conclusions: Patients with SD have limitations across multiple domains of QOL, including physical functioning and mental health. Exercise capacity measured by SAS is one of the good indicators that imply QOL in the community patients with SD. Treatment for exercise capacity may be important to improve physical and mental health for patients with SD.