对不同中医证候、心功能分级的射血分数保留型心力衰竭患者生存质量的探讨OA

Objective To assess health-related quality of life(HRQOL)in patients with heart failure with preserved ejection fraction(HFpEF)across different traditional Chinese medicine(TCM)syndromes and New York Heart Association(NYHA)functional classification.Methods This cross-sectional observational study used quota sampling to enroll 253 patients with HFpEF from 12 centers,including The First Affiliated Hospital of Guangzhou University of Chinese Medicine.Patients were stratified by NYHA classification and categorized into three TCM syndrome groups:qi deficiency with blood stasis(Qi-DBS,n=112),yang deficiency with blood stasis(Yang-DBS,n=83),and qi-yin deficiency with blood stasis(Qiyin-DBS,n=58).Data collected included demographic characteristics,NYHA class,comorbidities,brain natriuretic peptide levels,left ventricular ejection fraction.Evaluate patients' quality of life using Minnesota Living with Heart Failure Questionnaire(MLHFQ)scores.Statistical analyses included Spearman's correlation between MLHFQ scores and NYHA class,one-way analysis of variance/Kruskal-Wallis H test for quality of life comparisons across NYHA classes and TCM syndromes,and analysis of covariance for confounding factor adjustments.Results Significant positive correlations were observed among all domains and overall scores in patients with HFpEF(P＜0.05).In contrast,NYHA class showed negative correlations with all MLHFQ domains and overall scores(P＜0.05).Patients with Qi-DBS exhibited significantly higher physical,miscellaneous,and overall scores than those with Qiyin-DBS and Yang-DBS(P＜0.05).Among NYHA Class Ⅲ patients,those with Qi-DBS scored higher than those with Qiyin-DBS and Yang-DBS in the physical domain and overall scores,and outperformed patients with Yang-DBS in the miscellaneous domain(P＜0.05).Among NYHA Class Ⅳ patients,patients with Qi-DBS scored higher than those with Yang-DBS in the physical domain and surpassed both patients with Qiyin-DBS and Yang-DBS in the overall score(P＜0.05).Notably,Qi-DBS NYHA Class Ⅳ patients showed reduced physical domain score compared to NYHA Class Ⅲpatients(P＜0.05).Patients with Qiyin-DBS demonstrated progressive declines in physical,psychological domains,and overall scores from NYHA Class Ⅱ to Ⅳ,with NYHA Class Ⅳ patients scoring lower than Class Ⅲ patients in the miscellaneous domain(P＜0.05).Similarly,patients with Yang-DBS exhibited decreasing scores in the physical,miscellaneous domain,and overall scores from NYHA Class Ⅱ to Ⅳ,and NYHA Class Ⅲ patients also showed reduced psychological domain score compared with Class Ⅱ patients(P＜0.05).Conclusion HRQOL domain-specific profiles varied significantly among patients with HFpEF with different NYHA classes and TCM syndromes.Tailored management strategies based on TCM syndrome differentiation and the NYHA classification may optimize HRQOL improvements in clinical practice.