Research On The Influence Of Social Support Level On The Quality Of Life Of Patients With Chronic Heart Failure

ObjectiveThe social support status of patients with chronic heart failure(CHF)was evaluated by the social support scale(SSRS)of xiao shuiyuan,To explore the influence of social support on the quality of life of CHF patients and the changes of quality of life of CHF patients with different social support levels within six months after discharge and to provide guidance for improving the quality of life,prognosis and chronic disease management of CHF patients.Methods1.The patients admitted for CHF from March 1,2017 to May 31,2018,who voluntarily participated in follow-up survey,conformed to following inclusion criteria and signed the informed consent.2.Inclusion criterias and exclusion criterias2.1 Inclusion criterias(1)According to the Chinese Heart Failure Diagnosis and Treatment Guide 2014,diagnosed CHF patients aged 18 years and older(including cardiomyopathy,ischemic/coronary heart disease,hypertension,structural heart disease,alcohol or drug abuse or Drug abuse,myocarditis,arrhythmia,unknown etiology/idiopathic,etc.;(2)the primary cause of hospitalization for heart failure;(3)including the first diagnosis of heart failure and acute exacerbation of chronic heart failure.2.2 Exclusion criterias(1)severe acute and chronic diseases such as malignant tumors,severe renal failure,severe liver disease;(2)within 30 days of acute myocardial infarction;(3)due to mental,cognitive dysfunction,dementia,etc.Patients who complete the questionnaire on their own and who cannot be completed with other people's interpretation.3.Research methods This study adopts a prospective cohort study method.After the patients were selected,the social support level was assessed by the the social support scale(SSRS scale)of Xiao shuiyuan,and the social support levels were divided into the low social support group(SSRS scores<22 points)and the middle social support group(SSRS scores 23-44 points).),high social support group(SSRS scores 45-65 points),1st month,6th months follow-up study after discharge,assessment of patients' quality of life(EQ-5 D scale,KCCQ-12 scale),The differences in quality of life between CHF patients were compared between the low social support group,the middle social support group,and the high social support group.4.The baseline data of the patients were collected,including annual family income,gender,marriage,age,education level,weekly exercise time,working status,etc.Clinical data included etiology,past medical history(hypertension,diabetes,stroke,etc.),physical signs and laboratory indicators at admission,imaging examination,cardiac function grading(NYHA cardiac function grading),6-minute walking test,clinical adverse events(successful resuscitation after cardiac arrest,myocardial infarction,death).5.Patients were followed up by telephone at 1st and 6th month after discharge,and questionnaires(KCCQ-12 score,EQ-5D score,Drug adherence MMAS-4),number of re-hospitalization,and incidence of clinical adverse events(myocardial infarction,stroke,successful resuscitation after cardiac arrest,and death)were collected.6.Creating the database of the obtained data,.The data were statistically analyzed using the SPSS 17.0 statistical software package.The basic description of the count data and the composition ratio were used.The normal distribution measurement data was expressed by the mean data±standard deviation(x±s),and the hypothesis test count The data were compared using the 2 test.Anova of completely random design data was used for multi-group comparison of normal distribution measurement data,lsd-t test was used for pair-wise comparison,and anova of repeated design data was used for intra-group difference at different time points and inter-group difference comparison.Analysis of variance,correlation analysis using pearson correlation analysis,multiple regression analysis was used to establish multiple linear regression models,p<0.05 indicates that the difference was statistically significant.Results1.A total of 157 patients were enrolled in the study.One patient died in the hospital.Two patients were evacuated during hospitalization.9 patients died after discharge.145 patients were actually enrolled,including 88 males(60.7%)and 57 females(39.3%).),the average age is 60±12.9 years old,65 people in high social support group(45%),63 people in middle social support group(43%),17 people in low social support group(12%),social support total score 41.48±9.29 points,subjective support(23.54±6.91)points,objective support(10.00±3.14)points,support utilization(7.87±2.57)points,and average social support total separation in the middle social support level.Comparison of education level:the low social support group accounted for 7.6%of primary and secondary schools and below,the junior high school and high school accounted for 2.1%,the university and above accounted for 2.1%,and the moderate social support group accounted for 2.1%of the primary and secondary schools.20%,junior high school and high school accounted for 14.5%,university and above accounted for 8.9%,high social support group primary school and below accounted for 7.6%,junior high school and high school accounted for 22%,university and above accounted for The ratio is 15.2%.Comparison of marital status:The proportion of married people in the low social support group is 6.2%,the proportion of divorced or separated is 2.1%,the number of widowed is 3.4%,and the number of unmarried people is 0.The proportion of married people in the moderate social support group is 34.5%,divorced or separated is 4.1%,widowed is 4.1%,unmarried is 0.7%;highly social support group is 42.1%married,divorced or separated 0.7%,the proportion of widows is 2.1%,and the proportion of unmarried people is O.Weekly exercise time comparison:low social support group(1.95±0.79 h)vs middle social support group(3.07±1.20 h)vs high social support group(4.85±1.13 h),the difference was statistically significant(p<0.05)).2.There were significant differences in gender,education level,family income,and weekly exercise time among the low social support group,the middle social support group,and the high social support group(p<0.05),including males in the high social support group.Compared with the married couple,the family income and weekly exercise time are higher than the low social support group and the high social support group;the low social support group,the middle social support group,and the high social support group compare the clinical indicators:potassium The difference of left internal diameter was statistically significant(p<0.05),and the other indicators were not statistically significant.There were significant differences in ischemic/coronary heart disease and arrhythmia between the three groups(p<0.05).),the remaining indicators were not statistically significant(p>0.05).3.Comparison of quality of life in low social support group,middle social support group,and high social support group:There was no significant difference in EQ-5D score,EQ-5D visual score,and KCCQ-12 score between the 2nd day of hospitalization(p>0.05).On the 7th day,the EQ-5D score and EQ-5D visual score were statistically significant(p<0.05);the first month and 6 months after discharge,EQ-5D score,EQ-5D visual score,KCCQ-12 scores were statistically significant(p<0.05),suggesting an EQ-5D score,EQ-5D visual score,and KCCQ-12 score comparison:low social support group<middle social support group<high social support group,The quality of life of the low social support group at different time points was lower than that of the middle social support group and the high social support group.4.Analysis of variance of repeated design data showed that the EQ-5D score was statistically significant(P=6.697,p<0.001)on the 2nd day,7th day after admission,and 1st month and 6th month after discharge,indicating that the quality of life with the CHF patient was the worst On the 2nd day of admission,with the treatment of heart failure,the EQ-5D score showed an overall upward trend;The difference between the low social support group,the middle social support group,and the high social support group(F=8.021,p<0.001)was statistically significant,Further comparisons between LSD-t were made.The differences between the low social support group and the middle social support group,the low social support group and the high social support group,the middle social support group and the high social support group were statistically significant(p<0.05);EQ-5D visual score showed a statistically significant difference on 2nd?7th day after admission,1st?6th month after discharge(F=4.325,p=0.040),suggesting that EQ-5D visual score increased with the treatment of chronic heart failure.There were significant differences in the inter-subjectivity effect test(F=4.342,P=0.015)among the low social support group,the middle social support group and the high social support group.Further LSD-t comparisons showed that there were significant differences between the high social support group and the low social support group,the middle social support group and the high social support group(p<0.05),while there was no significant difference between the low social support group and the middle social support group(p>0.05).The KCCQ-12 score was statistically significant on the 2nd day after admission,1st month and 6th month after discharge(F=31.452,p<0.001),suggesting that the KCCQ-12 score increased with time.There was a statistically significant difference in the intersubject effect test(F=11.21,p<0.001)between the high social support group,the middle social support group,and the low social support group.Further comparisons between LSD and t were made.The differences between the low social support group and the middle social support group,the low social support group and the high social support group,the middle social support group and the high social support group were statistically significant(p<0.05).5.Among the patients in the low social support group,the middle social support group,and the high social support group,the drug compliance score at the first month of follow-up was:low social support group(1.41±0.68 points)vs social support group(2.83±0.91 points)vs high social support group(3.01±0.70 points),the difference was statistically significant,further LSD-t comparison,low social support group and middle social support group,low social support group and middle social support group,Chinese social support There were significant differences between the group and the high social support group(p<0.05).The drug compliance score at the 6th month follow-up was:low social support group(1.70±1.10 points)vs social support group(2.49±1.03 points)vs high social support group(2.72±1.10 points),the difference was statistically significant.Further differences between the LSD-t and the high social support group and the low social support group,the low social support group,and the middle social support group were statistically significant(p<0.05).There was no difference between the middle social support group and the high social support group.Statistical significance(p>0.05),suggesting that the higher the degree of social support in patients with CHF,the better drug compliance.6.Correlation analysis between social support and EQ-5D score and KCCQ-12 score during hospitalization:EQ-5D score and subjective support(r=0.21,p=0.043),total social support score(r=0.21,p=0.043),KCCQ score was correlated with subjective support(r=0.24,p=0.031)and total social support score(r=0.24,p=0.031),suggesting that social support scores increased and quality of life increased.Multiple linear regression analysis results:social support score(?=3.06),6-minute walk test(?=0.85)and EQ-5D score were positively correlated,NYHA cardiac function grade(?=-6.98)was negatively correlated with EQ-5D score.The social support score(P=2.13)was positively correlated with the KCCQ score,NYHA cardiac function score(?=-10.18),and BNP(?=-0.02)was negatively correlated with the KCCQ score.Conclusions1.The overall social support level of CHF patients is at a medium level,and social support can affect the quality of life of CHF patients;2.Social support is closely related to the quality of life of CHF patients.Increasing social support for patients can improve the quality of life of patients;3.Patients with chronic heart failure with high social support have better drug adherence,the higher social support level,the better drug adherence;4.A better social support system has a positive impact on the quality of life of patients with heart failure.The higher the level of social support,the better the quality of life recovery after discharge.