慢性心力衰竭患者疾病进展恐惧风险预测模型的构建及验证

Development and validation of a risk prediction model for Fear of Progression in patients with Chronic Heart Failure

目的 :分析慢性心力衰竭患者疾病进展恐惧的现状和影响因素,构建风险预测模型并验证模型的预测效果。方法 :采取便利抽样法,选取2021年11月至2022年3月在2所三级甲等医院心血管内科住院治疗的慢性心力衰竭患者作为建模组研究对象,将其分为疾病进展恐惧心理功能失调组(64例)和未失调组(124例),以自我调节常识模型为理论框架,根据Logistic回归分析结果构建风险预测模型。采用Hosmer-Lemeshow检验判断模型的拟合度,受试者操作特征(ROC)曲线下面积检验模型的预测效能,并选取80例慢性心力衰竭患者进行模型预测效果的验证。结果 :慢性心力衰竭患者疾病进展恐惧心理功能失调的发生率为34.04%。年龄(OR=0.909)、左房内径(OR=1.074)、美国纽约心脏病协会心功能Ⅱ级(OR=9.156)、非心血管合并症数目(OR=4.222)、心力衰竭躯体感知情况(OR=1.153)、心理弹性的坚韧性情况(OR=0.749)、心力衰竭自我护理信心情况(OR=0.926)是其影响因素(P<0.05)。预测模型的ROC曲线下面积为0.926,灵敏度为81.5%,特异度为89.1%,约登指数最大值为0.706,预测准确率为88.75%。结论 :本研究构建的慢性心力衰竭患者疾病进展恐惧风险预测模型具有良好的预测效能,适用于临床筛查,可为护理人员识别高危人群并采取有针对性的积极心理干预提供参考。

Objective:To investigate the current status and influencing factors of Fear of Progression(FoP)in patients with Chronic Heart Failure(CHF),to construct a risk prediction model and to verify the prediction effect of the model.Methods:A total of 188 patients with CHF who hospitalized in the department of cardiology of 2 tertiary hospitals from November 2021 to March 2022 were selected as the subjects by convenience sampling.The risk factors between dysfunctional FoP group(n=64)and non-dysfunctional FoP group(n=124)were compared.The risk prediction model was constructed with Logistic regression analysis using the self-regulation common sense model as the theoretical framework.Hosmer-Lemeshow test was used to test the goodness of fit and the area under the Receiver Operating Characteristic curve(AUC)was used to evaluate the efficacy of the model.Eighty CHF patients were selected to verify the prediction effect of the model.Results:The incidence of dysfunctional FoP in patients with CHF was 34.04%.Age(OR=0.909),left atrial diameter(OR=1.074),New York Heart Association function classification(OR=9.156),number of non-cardiovascular comorbidities(OR=4.222),Heart Failure Somatic Perception Scale score(OR=1.153),Connor-Davidson Resilience Scale-10 item(OR=0.749),and Self-care of Heart Failure Index(OR=0.926)were independent influencing factors of dysfunctional FoP in patients with CHF(P<0.05).The AUC of the model was 0.926,the sensitivity was 81.5%,the specificity was 89.1%,and the Youden index was 0.706.The prediction accuracy was 88.75%.Conclusion:The risk prediction model for FoP in patients with CHF constructed in this study has good predictive effects,which is suitable for clinical screening.It might provide a scientific reference for nursing staff to identify high-risk populations and to take targeted positive psychological interventions.