Mejhert M, Kahan T, Persson H, Edner M
Karolinska Institutet Danderyd Hospital, Section of Cardiology, S-182 88 Stockholm, Sweden.
Heart. 2004 Sep;90(9):1010-5. doi: 10.1136/hrt.2003.014407.
To evaluate the effects of a nurse based outpatient management programme for elderly patients discharged with heart failure from a university hospital.
Patients with heart failure (New York Heart Association class II-IV) and left ventricular systolic dysfunction aged 60 years or more were randomly assigned to follow up within the management programme or to conventional follow up, usually in primary care. Of the 208 participants, 58% were men, mean age was 75 years, and mean ejection fraction 34%. All patients were scheduled for three observational study visits at six month intervals. The primary end point was quality of life (QoL) and secondary end points were hospitalisation and mortality.
More patients achieved target doses of angiotensin converting enzyme (ACE) inhibitors in the intervention group than in the control group (82% v 69%, 88% v 69%, and 88% v 74% of recommended target doses at 6, 12, and 18 months of follow up, respectively, p < 0.05 for all). Patients with initial low QoL had a poor prognosis. After a mean 1122 days of follow up, 82% of all patients had been readmitted. There were on average 4.7 readmissions per patient and 66% were due to non-cardiac diagnoses. There were no differences in QoL or health care consumption between the two study groups during follow up.
A nurse based management programme is more effective than follow up in primary care in optimising medication for elderly patients with heart failure. However, such a programme does not seem to have a favourable influence on QoL or readmission rate during long term follow up.
评估一项基于护士的门诊管理项目对从大学医院出院的老年心力衰竭患者的效果。
年龄60岁及以上、患有心力衰竭（纽约心脏协会II-IV级）且左心室收缩功能障碍的患者被随机分配至管理项目组或常规随访组，常规随访通常在初级保健机构进行。208名参与者中，58%为男性，平均年龄75岁，平均射血分数为34%。所有患者均计划每隔6个月进行3次观察性研究访视。主要终点是生活质量（QoL），次要终点是住院率和死亡率。
干预组中达到血管紧张素转换酶（ACE）抑制剂目标剂量的患者比对照组更多（分别在随访6个月、12个月和18个月时，达到推荐目标剂量的比例为82%对69%、88%对69%和88%对74%，所有p值均<0.05）。初始生活质量较低的患者预后较差。经过平均1122天的随访，82%的患者再次入院。每位患者平均再次入院4.7次，66%是由于非心脏诊断。在随访期间，两个研究组在生活质量或医疗保健消耗方面没有差异。
对于老年心力衰竭患者，基于护士的管理项目在优化药物治疗方面比初级保健随访更有效。然而，这样一个项目在长期随访期间似乎对生活质量或再入院率没有有利影响。
