The Application Of SF-36 In Assessment Of Health-related Quality Of Life In Chinese Patients With Congestive Heart Failure

Objectives: (1) to evaluate the feasibility of the Chinese version of the 36-items short form health survey (SF-36) in assessment of the health-related quality of life (HRQOL) in Chinese patients with congestive heart failure (CHF). (2) to assess the HRQOL of patients with CHF and make comparisons with the general population. (3) to investigate the impact of demographic data and clinical characteristics on the different aspects of HRQOL.Methods: 128 patients diagnosised definitely with CHF (NYHA Ⅰ-Ⅳ) selected from inpatient and some of outpatients with long term follow-up of our hospital and the first hospital of Yangzhou city were recruited in this study. The HRQOL of patients were assessed with a Chinese version of SF-36 and the Minnesota living with heart failure questionnaire (MHFQ) simultaneously. The parts of patients were assessed again after follow up. The patients cardiac structure, function and exercise capacity were evaluated respectively with echocardiogram and 6-minutes walk test (6-WT) .Results: (1) SF-36 showed good internal consistency (every Cronbach's a of eight dimensions was more than 0.70) and repeatability. Factor analysis resulted in two factors that were consistent with the theory construct hypothesis on the whole. 78 patients completed follow-up during 4-8 weeks. Appling SF-36 and MHFQ might not only detect the change of the overall HRQOL scores, but also SF-36 might differentiate the alteration in mental health components (MHC) scores during follow-up in 40 gotten better patients. (2) CHF patients HRQOL scores in eight dimensions of SF-36 were significantly lower than those of general population and reduced to 30.7%-52.3%, especially in physical function, role physical and bodily pain. The classification proportion (good, moderate, bad) of SF-36 overall score in patients with CHF made a great difference with normal Chinese old population. All dimensions scores weregradually decreased along with the increase of NYHA classification and reduced to 33.2%-64.4% in NYHA class IV group, especially. In subgroup analyses, the scores of dimensions in physical function, vitality, social function, mental health in left ventricular end diastolic diameter (LVEDD ) <63 mm group were higher than those in LVEDD≥63 mm group. The scores of physical function, role physical, general health, role emotional in 6-WT <410 m group were lower than those of 6-WT ≥410 m group. In contrast, the degree of systolic dysfunction ( different left ventricular ejection fraction, LVEF ) had no impact on the HRQOL. (3) In correlation analyses, there were significant difference in the extent and degree of influence on patients HRQOL of demographic data and clinic characteristics and no consistent correlation was found among all variables and dimensions of HRQOL. NYHA functional class, LVEDD, 6-WT was low-grade to moderate correlation with few dimensions and overall scores of HRQOL. NYHA classification and 6-WT had relative important effects on physical health components (PHC) scores and MHC scores. (4) In multivariate regression analyses, the effect of sole factor among common demographic data on dimensions of HRQOL was mild. Among clinic variables, NYHA functional class, LVEDD, 6-WT showed relative important to HRQOL comparison with others variables. But all demographic and clinic variables accounted for 21.5%-41.8% of the variance in different dimensions of HRQOL and 50.2%, 27.6%, 42.7% of the variance in overall score, PHC, MHC of SF-36, respectively.Conclusions: (1) The Chinese version of SF-36 still showed good reliability, validity and responsiveness in assessment of CHF patient HRQOL. (2) all dimensions of HRQOL in patients with CHF gradually declined along with the increase of NYHA functional class compared with general population. (3) The extent and degree of influence on patients HRQOL of common demographic data and clinic characteristics were significant different. The severity of condition showed relative important to HRQOL comparison with the demographic data. But the predictive values of all v...