Jovicic Aleksandra, Holroyd-Leduc Jayna M, Straus Sharon E
Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, Ontario, M5S 3G8, Canada.
BMC Cardiovasc Disord. 2006 Nov 2;6:43. doi: 10.1186/1471-2261-6-43.
Heart failure is the most common cause of hospitalization among adults over 65. Over 60% of patients die within 10 years of first onset of symptoms. The objective of this study is to determine the effectiveness of self-management interventions on hospital readmission rates, mortality, and health-related quality of life in patients diagnosed with heart failure.
The study is a systematic review of randomized controlled trials. The following data sources were used: MEDLINE (1966-11/2005), EMBASE (1980-11/2005), CINAHL (1982-11/2005), the ACP Journal Club database (to 11/2005), the Cochrane Central Trial Registry and the Cochrane Database of Systematic Reviews (to 11/2005); article reference lists; and experts in the field. We included randomized controlled trials of self-management interventions that enrolled patients 18 years of age or older who were diagnosed with heart failure. The primary outcomes of interest were all-cause hospital readmissions, hospital readmissions due to heart failure, and mortality. Secondary outcomes were compliance with treatment and quality of life scores. Three reviewers independently assessed the quality of each study and abstracted the results. For each included study, we computed the pooled odds ratios (OR) for all-cause hospital readmission, hospital readmission due to heart failure, and death. We used a fixed effects model to quantitatively synthesize results. We were not able to pool effects on health-related quality of life and measures of compliance with treatment, but we summarized the findings from the relevant studies. We also summarized the reported cost savings.
From 671 citations that were identified, 6 randomized trials with 857 patients were included in the review. Self-management decreased all-cause hospital readmissions (OR 0.59; 95% confidence interval (CI) 0.44 to 0.80, P = 0.001) and heart failure readmissions (OR 0.44; 95% CI 0.27 to 0.71, P = 0.001). The effect on mortality was not significant (OR = 0.93; 95% CI 0.57 to 1.51, P = 0.76). Adherence to prescribed medical advice improved, but there was no significant difference in functional capabilities, symptom status and quality of life. The reported savings ranged from 1300 to 7515 dollars per patient per year.
Self-management programs targeted for patients with heart failure decrease overall hospital readmissions and readmissions for heart failure.
心力衰竭是65岁以上成年人住院治疗最常见的原因。超过60%的患者在首次出现症状后的10年内死亡。本研究的目的是确定自我管理干预措施对心力衰竭患者再入院率、死亡率及健康相关生活质量的有效性。
本研究是一项对随机对照试验的系统评价。使用了以下数据来源：MEDLINE（1966年至2005年11月）、EMBASE（1980年至2005年11月）、CINAHL（1982年至2005年11月）、美国内科医师学会杂志俱乐部数据库（截至2005年11月）、Cochrane中心试验注册库和Cochrane系统评价数据库（截至2005年11月）；文章参考文献列表；以及该领域的专家。我们纳入了针对18岁及以上被诊断为心力衰竭患者的自我管理干预随机对照试验。感兴趣的主要结局是全因再入院、因心力衰竭再入院及死亡率。次要结局是治疗依从性和生活质量评分。三名评审员独立评估每项研究的质量并提取结果。对于每项纳入研究，我们计算了全因再入院、因心力衰竭再入院及死亡的合并比值比（OR）。我们使用固定效应模型对结果进行定量综合分析。我们无法对健康相关生活质量及治疗依从性测量结果进行合并分析，但我们总结了相关研究的结果。我们还总结了报告的成本节约情况。
从识别出的671篇文献中，本评价纳入了6项随机试验，共857例患者。自我管理降低了全因再入院率（OR 0.59；95%置信区间（CI）0.44至0.80，P = 0.001）和心力衰竭再入院率（OR 0.44；95%CI 0.27至0.71，P = 0.001）。对死亡率的影响不显著（OR = 0.93；95%CI 0.57至1.51，P = 0.76）。对规定医疗建议的依从性有所改善，但在功能能力、症状状态和生活质量方面无显著差异。报告的节约成本为每位患者每年1300至7515美元。
针对心力衰竭患者的自我管理项目可降低总体再入院率及因心力衰竭的再入院率。
