Gwadry-Sridhar Femida H, Arnold J Malcolm O, Zhang Ying, Brown James E, Marchiori Gordon, Guyatt Gordon
Division of Critical Care, London Health Sciences Centre, London, Ontario, Canada.
Am Heart J. 2005 Nov;150(5):982. doi: 10.1016/j.ahj.2005.08.016.
Patients with heart failure (HF) face challenges complying with multidrug regimens.
To examine the impact of a compliance enhancing intervention on medication compliance and morbidity in HF.
Patients were randomized to either usual care or an inhospital educational intervention delivered by a multidisciplinary team (Intervention).
Acute medical and surgical units at a teaching hospital.
One hundred thirty four patients with a clinical diagnosis of HF and a left ventricular ejection fraction of < 40% requiring long-term medical treatment.
A validated HF-specific instrument provided a measure of knowledge. We characterized patients as noncompliant if pharmacy refill data suggested they had taken < or = 0.80 of their medication. We measured quality of life using the Minnesota Living with Heart Failure Questionnaire and the Short Form 36 and conducted a time to first event analysis of a composite end point including mortality, readmissions, and emergency department visits.
The Intervention group showed higher knowledge scores at discharge and 1 year (P = .05). The risk of noncompliance in Intervention patients varied from 0.78 (95% CI 0.33-1.89) for ACE-I (13% Intervention, 17% Control) to 1.02 (0.49-2.12) for diuretics (23% Intervention, 23% Control). Quality of life improved in both groups over time; the only difference between groups favored the Intervention (Minnesota Living with Heart Failure Questionnaire, P = .04). The composite end point occurred in 67% of control and 60% of Intervention patients (hazard ratio 0.85, 95% CI 0.55-1.30).
An inhospital educational intervention improved knowledge and, possibly, quality of life and may be useful as part of a comprehensive compliance enhancing strategy in patients with HF.
心力衰竭（HF）患者在遵守多种药物治疗方案方面面临挑战。
研究一项提高依从性的干预措施对HF患者药物依从性和发病率的影响。
将患者随机分为常规治疗组或由多学科团队实施的住院教育干预组（干预组）。
一家教学医院的急性内科和外科病房。
134例临床诊断为HF且左心室射血分数<40%需要长期药物治疗的患者。
一种经过验证的特定于HF的工具提供了知识测量。如果药房的再填充数据表明患者服用的药物<或=0.80，则将其归类为不依从。我们使用明尼苏达心力衰竭生活问卷和简短健康调查问卷36项来测量生活质量，并对包括死亡率、再入院率和急诊就诊在内的复合终点进行首次事件时间分析。
干预组在出院时和1年时的知识得分更高（P = 0.05）。干预组患者不依从的风险因药物而异，从ACE-I的0.78（95%CI 0.33 - 1.89）（干预组13%，对照组17%）到利尿剂的1.02（0.49 - 2.12）（干预组23%，对照组23%）。随着时间的推移，两组的生活质量均有所改善；两组之间唯一的差异有利于干预组（明尼苏达心力衰竭生活问卷，P = 0.04）。复合终点在67%的对照组患者和60%的干预组患者中出现（风险比0.85，95%CI 0.55 - 1.30）。
住院教育干预提高了知识水平，可能还改善了生活质量，并且可能作为HF患者综合依从性增强策略的一部分发挥作用。
