患者の予測寿命とモデルの予測寿命の不一致は,心不全の ambulatory 患者の間で見られる
Larry A Allen1, Jonathan E Yager, Michele Jonsson Funk
1Duke Clinical Research Institute and Division of Cardiology, Durham, NC 27705, USA. larry_allen@post.harvard.edu
JAMA
|June 5, 2008
まとめ
心不全の患者は,しばしば自分の平均寿命を過大評価する. 患者の期待値と生存に関する臨床予測の間のこの不一致は,より良い終末期ケア計画のためのさらなる調査を正当化します.
科学分野:
- 心臓病学 心臓病学
- 医学的予後について
- 患者の期待について
背景:
- 慢性心不全 (CHF) は,長期的な生存率の低下と関連しています.
- CHFの予後に関する患者特有の期待はよく理解されていません.
研究 の 目的:
- 心不全患者の生存期待値を定量化するために.
- 患者の予測した予後とモデルベースの予測を比較する.
- 予後認識における不一致に影響を与える要因を特定する.
主な方法:
- 122人の心不全の患者さんを対象とした前向きな調査.
- 視覚アナログスケールで評価された患者の平均寿命.
- モデルの予測寿命は,シアトル心不全モデルを用いて計算された.
- 観察された生存率を決定するために,2008年2月までのフォローアップ.
主要な成果:
- 患者は平均して,自分の平均寿命を過大評価していた (患者による平均寿命予測は13.0年,モデルによる平均寿命予測は10.0年).
- 平均寿命比 (LER) は1.4でした.
- 年齢の若さ,ニューヨーク・ハート・アソシエーション (NYHA) クラスの高さ,エジェクション分数の低さ,うつ病の減少は,より高いLERを予測した.
- 過大評価された平均寿命 (より高いLER) と生存率の改善との間には関連性が見つかりませんでした.
結論:
- 歩行性心不全の患者は,モデル予測と比較して,寿命を大幅に過大評価する傾向があります.
- 認知された生存率の不一致は,先進的な治療法と終末期計画に関する決定に影響を与える可能性があります.
- これらの予測の違いの背後にある理由を理解するために,さらなる研究が必要です.
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