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문제 정의
- This cross-sectional study aimed to examine the relationships between the NT-proBNP levels and related factors of patients with heart failure. The study utilized a convenience sample of adult outpatients and inpatients who attended a cardiology department in a tertiary hospital in Seoul, Korea.
제안 방법
- The present study has some limitations. First, the findings from this study cannot be generalized, because the research was based on convenience sampling from patients at a single hospital, and most of the patients were outpatients with minor symptoms. Therefore, similar studies in patients with different heart failure severities are required in the future.
- One randomized controlled trial compared NT-proBNP-guided care with standard care management, that is, without NT-proBNP guidance, in patients with heart failure. In the NT-proBNP-guided care arm, an additional goal was to lower and sustain the NT-proBNP levels, and additional clinic visits and medication adjustments occurred. This study’s findings suggested that serial changes in the NT-proBNP levels were a risk for adverse outcomes, and that NT-proBNP-assisted treatments were associated with improvements in the clinical outcomes [22].
- The High group was used as the reference group, and the adjusted odds ratios (ORs) for age, sex, the employment status, arrhythmias, the NYHA FC, the number of medicines, rehospitalizations within 1 year, emergency room visits within 1 year, the LVEF, comorbidities, self-care behaviors, and the physical symptom experiences were used in the final model (Table 4). Compared with the patients in the High group, the patients in the Low group were 5.
- [19]. The instrument is based on a four-point Likert scale, and it consists of 10 physical symptom items, including dyspnea, leg/ankle edema, anorexia, and fatigue. The instrument was modified by our research team to assess the symptoms, and to report the frequency and intensity of each symptom separately.
- The instrument is based on a four-point Likert scale, and it consists of 10 physical symptom items, including dyspnea, leg/ankle edema, anorexia, and fatigue. The instrument was modified by our research team to assess the symptoms, and to report the frequency and intensity of each symptom separately. The patients responded to the questionnaire using the four-point Likert scale, and the responses ranged from “none” (0 points) to “severe” (4 points) for both frequency and intensity; therefore, the mean of the two scores for each symptom ranged from 0 to 4.
- The patients responded to the questionnaire using a five-point Likert scale with answers that ranged from 1=“completely disagree” to 5 =“completely agree”.
- The patients responded to the questionnaire using the four-point Likert scale, and the responses ranged from “none” (0 points) to “severe” (4 points) for both frequency and intensity; therefore, the mean of the two scores for each symptom ranged from 0 to 4.
- The patients’ clinical data were extracted from the patients’ EMRs, and they included data that described the New York Heart Association (NYHA) functional classification (FC) that graded the severity of the functional limitations associated with physical activity, the cause of heart failure, the LVEF, the presence of arrhythmias, the types and numbers of prescribed medications, the heart surgery and percutaneous coronary intervention histories, the comorbidities, the numbers of emergency room visits and rehospitalizations within 1 year, and the NT-proBNP level.
- The patients’ sociodemographic data were obtained by using a questionnaire that gathered data about the patient’s sex, age, marital status, education, employment status, and monthly income.
- The purpose of this study was to identify the patients’ characteristics, self-care behaviors, and physical symptom experiences in association with NT-proBNP, and to determine whether or not the NT-proBNP levels differed among the factors investigated.
- The research objectives, the methods, and the study’s duration were explained to the patients, and the patients were provided with detailed information regarding their participation in the research.
- 05. The sociodemographic and clinical characteristics of the patients and the major variables were analyzed using univariate analysis for inclusion in the regression model to examine related factors to NT-proBNP groups. The continuous variables, such as self-care behaviors and physical symptom experiences were anaylzed using an analysis of variance (ANOVA).
- This study examined the relationships between the patients’ NT-proBNP levels and their sociodemographic and clinical characteristics, self-care behaviors, and physical symptom experiences.
대상 데이터
- A total of 154 patients were included in the final analyses, with a 91% rate of return. The data collected were encoded and processed into statistical data using IBM®SPSS® software, version 20.
- 1%) were male. Most of the patients were married (107 patients; 69.5%), and 54 (35.1%) patients were employed (Table 1). Sixty-three patients (40.
- The clinical data were extracted from the electronic medical records (EMRs) of 154 patients with heart failure who attended a tertiary medical center. The general rule for calculating the sample size for multinomial logistic regression is a minimum ratio of 10 cases to each independent variable, with a minimum sample size of 100 or 50 [17].
- The data were collected from October 2013 to November 2013 from heart failure outpatients and inpatients who attended the circulatory internal medicine and cardiology departments at Samsung Medical Center, which is a tertiary medical center in Seoul, Korea. The self-administered survey questionnaires and the EMRs were used to collect the data
- This cross-sectional study aimed to examine the relationships between the NT-proBNP levels and related factors of patients with heart failure. The study utilized a convenience sample of adult outpatients and inpatients who attended a cardiology department in a tertiary hospital in Seoul, Korea.
데이터처리
- And the categorical variables, such as NYHA classification, the cause of heart failure, the LVEF, the presence of arrhythmias, the types and numbers of prescribed medications, the history of heart surgery and percutaneous coronary intervention histories, the comorbidities, the numbers of emergency room visits and rehospitalizations within 1 year were analyzed using Pearson’s chi-square test.
- The Scheffé post-hoc test was used for multiple-comparison for the ANOVA results.
- The sociodemographic and clinical characteristics of the patients and the major variables were analyzed using univariate analysis for inclusion in the regression model to examine related factors to NT-proBNP groups. The continuous variables, such as self-care behaviors and physical symptom experiences were anaylzed using an analysis of variance (ANOVA). And the categorical variables, such as NYHA classification, the cause of heart failure, the LVEF, the presence of arrhythmias, the types and numbers of prescribed medications, the history of heart surgery and percutaneous coronary intervention histories, the comorbidities, the numbers of emergency room visits and rehospitalizations within 1 year were analyzed using Pearson’s chi-square test.
- The regression analysis was preceded by Pearson’s correlation to identify multicollinearity between the independent variables.
- The significant variables identified by the univariate analysis were included as the independent variables and the NT-proBNP groups were included as the dependent variables in the multinomial logistic regression. Age and sex were the confounding factors, and self-care was added as an independent variable, because it was a major factor in this study.
이론/모형
- The general rule for calculating the sample size for multinomial logistic regression is a minimum ratio of 10 cases to each independent variable, with a minimum sample size of 100 or 50 [17]. In this study, 12 independent variables, including age and sex, were incorporated into the multivariate models. The sample size to the number of independent variables ratio was 12.
- The self-care behaviors were measured using the nine-item European Heart Failure Self-care Behavior (EHFScB-9) scale, an instrument that was developed for patients with heart failure by Jaarsma et al. [21] and that was translated, reverse-translated, and expert-verified by Son et al.
성능/효과
- Third, this study did not measure other heart failure biomarkers and psychological factors; hence, further research must be undertaken that includes psychological factors. Fourth, we could not consider age, sex, or renal function when the NT-proBNP groups were defined, because of the small number of patients, and this may have led to false-positive or false-negative results.
- In this study, the most frequent comorbidity was diabetes, and patients in the Low group (NT-proBNP < 380 mg/mL) were less likely to have comorbidities compared with the patients in the High group.
- 08). The occurrence of arrhythmias was lower in the Low group compared with the High group (OR, 0.04; 95% CI = 0.01-0.18). Compared with the patients in the High group, the patients in the Low group were 9.
후속연구
- Further studies are needed to investigate whether treatment and nursing guidance based on the NT-proBNP levels help to improve outcomes in a way that is more specifically suited to the individual needs of the patients.
- Second, the patients were enrolled over a relatively short period of time and the influence of seasonal variations on the symptoms of heart failure was not considered. Third, this study did not measure other heart failure biomarkers and psychological factors; hence, further research must be undertaken that includes psychological factors. Fourth, we could not consider age, sex, or renal function when the NT-proBNP groups were defined, because of the small number of patients, and this may have led to false-positive or false-negative results.
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