Qualidade de vida e indicadores clínicos na insuficiência cardíaca: Análise multivariada

Abstract

Background: In Heart Failure (HF), special attention must be given not only to objective or isolated aspects, but also to the patient's health self-perceptions. Subjective aspects can help healthcare providers understand and better treat HF. Objective: The objective of this study was to evaluate the simultaneous effects of clinical indicators of HF on the Quality-of-Life (QOL). Methods: We investigated, through a multivariate analysis, the QOL of 101 Brazilian HF outpatients using the Minnesota Living with Heart Failure Questionnaire (including subscales) and its correlation to clinical and physiological variables such as age, ethnicity, gender, echocardiogram parameters, body mass index, mean blood pressure at rest, time since diagnosis, Functional Classification according to the NYHA, functional capacity by a Specific Activity Scale, comorbidities, Framingham Score of Cardiac Risk (CR), Lung Function Test (spirometry) and Body Composition. Results: QOL showed significant univariate correlations to the echocardiogram: ejection fraction (p=0.0415), left ventricular diastolic diameter (LVDD) (p=0.004), left ventricular systolic diameter (LVSD) (p=0.0001); comorbidities (p=0.002) and Lung Function Test: Forced Vital Capacity (FVC) (p<0.0001), Forced Expiratory Volume in the 1st second (FEV1) (p<0.0001) and Maximal Voluntary Ventilation (MVV) (p=0.001). In the multivariate analysis, the backward stepwise protocol detected important simultaneous influent variables (r2=0.60): gender (0.000178), ethnicity (p<0.00001), LVSD (p<0.00001), CR (p=0.000002), FVC (p=0.002027), FEV1 (p<0.00001) and MVV (p=0.00001). Conclusion: Gender, ethnicity, LVSD, CR, FVC, FEV1 and MVV are independent predictors of HF patients' QOL. Simultaneously, they are responsible for about 60% of the QOL variance. Biopsychosocial aspects could contribute to patient and health professional expectations and treatment results.