关键词: 慢性心力衰竭, 老年人, 生活质量, 风险因素

Abstract:

Objective To examine the dynamic trajectory patterns of quality-of-life (QOL) decline in elderly patients with chronic heart failure (CHF) and to identify associated risk and protective factors. Methods From January 2023 to January 2025, 217 elderly CHF patients treated in the Department of Cardiovascular Medicine, the 989th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, were enrolled. QOL was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) at four time points: baseline (admission), and 1, 3, and 6 months after discharge. A latent growth mixture model (LGMM) was employed to identify heterogeneous QOL trajectory classes. Univariate and multivariate logistic regression analyses were performed to determine factors associated with trajectory membership. Results A total of 197 patients completed the entire follow-up (dropout rate 9.22%, completion rate 90.78%). LGMM identified three distinct QOL-decline trajectories: a persistently low-QOL group (n=35), a slowly declining group (n=121), and a rapidly declining group (n=41). Multivariate logistic regression showed that age ≥75 years, New York Heart Association (NYHA) class IV, left ventricular ejection fraction ≤35%, comorbid renal dysfunction, anemia, and depression were independent risk factors for belonging to the rapid-decline trajectory (all P<0.01). Adherence to prescribed medication and regular aerobic exercise were independent protective factors (both P<0.01). Conclusion Elderly CHF patients exhibit marked heterogeneity in QOL-decline trajectories. Early identification and targeted intervention for patients at high risk of rapid QOL deterioration, through enhanced medication management, promotion of regular exercise, and attention to psychological health, may help delay the decline in quality of life.

Key words: chronic heart failure, elderly, quality of life, risk factors