关键词: 冠心病, 心力衰竭, 老年, 症状群, 生活质量

Abstract: Objective To study symptom clusters and their influence on the quality of life in elderly patients with coronary heart disease complicated with heart failure. Methods Elderly patients with coronary heart disease complicated with heart failure who were admitted to the hospital from January 2021 to June 2022 were selected. The basic data including gender, age, education level, course of coronary heart disease, and cardiac function grading were obtained. The Chinese version of the Memorial Symptom Assessment Scale-Heart Failure （MSAS-HF） was used to investigate the occurrence and severity of symptoms. The exploratory factor analysis method was used to explore the types and composition of symptom clusters. The Minnesota Living with Heart Failure Questionnaire based on Chinese culture（C-MLHF） was used to evaluate the quality of life. The symptom clusters of elderly patients with coronary heart disease complicated with heart failure and their influence on the quality of life were analyzed. Results There were 1 228 effective subjects, with an effective rate of 96.01%. The high incidence of symptoms was short-winded （71.99%）, dyspnea when lying flat （66.69%）, fatigue （64.50%）, palpitation （61.89%）, etc. The high severity of symptoms was dyspnea when lying flat （2.95±0.63）, short-winded （2.92±0.59）, sleep difficulty （2.90±0.65）, fatigue （2.89±0.52）, etc. Five symptom clusters were obtained by exploratory factor analysis, which was fatigue symptoms （fatigue, sweating, and drowsiness）, dyspnea symptoms （dyspnea, oppressive wake, and dyspnea when lying flat）, ischemic symptoms （palpitation, dizziness, chest pain, and numbness of hands and feet）, congestion symptoms （short-winded, edema, and cough）, and psychological symptoms （anxiety, sadness, feeling nervous, and difficulty in concentrating）. The total score of C-MLHF was （62.87±11.05）, and the scores of the physical field, emotional field, and other fields were （42.36±8.90）, （11.54±5.16）, and （13.92±6.73）, respectively. The symptom clusters of elderly patients with coronary heart disease complicated with heart failure were positively correlated with quality of life （all P<0.05）. Fatigue symptoms （β'=0.267）, dyspnea symptoms （β'=0.173）, ischemic symptoms （β'=0.312）, congestion symptoms （β'=0.265）, and psychological symptoms （β'=0.277） were all influencing factors of quality of life in elderly patients with coronary heart disease complicated with heart failure. Conclusions Elderly patients with coronary heart disease complicated with heart failure have fatigue symptoms, dyspnea symptoms, ischemic symptoms, congestion symptoms, and psychological symptoms, which seriously affect the quality of life of patients. It is necessary to carry out targeted symptom management to reduce physical and mental discomfort and improve the quality of life of patients.

Key words: Coronary heart disease, Heart failure, The elderly, Symptom clusters, Quality of life