McAlister Finlay A, Stewart Simon, Ferrua Stefania, McMurray John J J V
Division of General Internal Medicine, University of Alberta, Edmonton, Canada.
J Am Coll Cardiol. 2004 Aug 18;44(4):810-9. doi: 10.1016/j.jacc.2004.05.055.
The aim of this study was to determine whether multidisciplinary strategies improve outcomes for heart failure (HF) patients.
Because the prognosis of HF remains poor despite pharmacotherapy, there is increasing interest in alternative models of care delivery for these patients.
Randomized trials of multidisciplinary management programs in HF were identified by searching electronic databases and bibliographies and via contact with experts.
Twenty-nine trials (5,039 patients) were identified but were not pooled, because of considerable heterogeneity. A priori, we divided the interventions into homogeneous groups that were suitable for pooling. Strategies that incorporated follow-up by a specialized multidisciplinary team (either in a clinic or a non-clinic setting) reduced mortality (risk ratio [RR] 0.75, 95% confidence interval [CI] 0.59 to 0.96), HF hospitalizations (RR 0.74, 95% CI 0.63 to 0.87), and all-cause hospitalizations (RR 0.81, 95% CI 0.71 to 0.92). Programs that focused on enhancing patient self-care activities reduced HF hospitalizations (RR 0.66, 95% CI 0.52 to 0.83) and all-cause hospitalizations (RR 0.73, 95% CI 0.57 to 0.93) but had no effect on mortality (RR 1.14, 95% CI 0.67 to 1.94). Strategies that employed telephone contact and advised patients to attend their primary care physician in the event of deterioration reduced HF hospitalizations (RR 0.75, 95% CI 0.57 to 0.99) but not mortality (RR 0.91, 95% CI 0.67 to 1.29) or all-cause hospitalizations (RR 0.98, 95% CI 0.80 to 1.20). In 15 of 18 trials that evaluated cost, multidisciplinary strategies were cost-saving.
Multidisciplinary strategies for the management of patients with HF reduce HF hospitalizations. Those programs that involve specialized follow-up by a multidisciplinary team also reduce mortality and all-cause hospitalizations.
本研究旨在确定多学科策略是否能改善心力衰竭（HF）患者的治疗效果。
尽管药物治疗，但HF患者的预后仍然很差，因此人们对为这些患者提供替代护理模式的兴趣日益浓厚。
通过检索电子数据库、参考文献以及与专家联系，确定HF多学科管理项目的随机试验。
共确定了29项试验（5039例患者），但由于存在相当大的异质性，未进行汇总分析。我们预先将干预措施分为适合汇总的同质组。由专业多学科团队进行随访（在诊所或非诊所环境中）的策略可降低死亡率（风险比[RR]0.75，95%置信区间[CI]0.59至0.96）、HF住院率（RR 0.74，95%CI 0.63至0.87）和全因住院率（RR 0.81，95%CI 0.71至0.92）。侧重于增强患者自我护理活动的项目可降低HF住院率（RR 0.66，95%CI 0.52至0.83）和全因住院率（RR 0.73，95%CI 0.57至0.93），但对死亡率无影响（RR 1.14，95%CI 0.67至1.94）。采用电话联系并建议患者病情恶化时就诊于初级保健医生的策略可降低HF住院率（RR 0.75，95%CI 0.57至0.99），但对死亡率（RR 0.91，95%CI 0.67至1.29）或全因住院率（RR 0.98，95%CI 0.80至1.20）无影响。在评估成本的18项试验中的15项中，多学科策略具有成本节约作用。
HF患者的多学科管理策略可降低HF住院率。那些涉及多学科团队专门随访的项目还可降低死亡率和全因住院率。
