Grancelli Hugo O
Grupo de Estudio de la Insuficiencia Cardiaca en la Argentina, GESICA, Buenos Aires, Argentina.
Rev Esp Cardiol. 2007 Oct;60 Suppl 3:15-22.
Despite significant advances in the treatment of heart failure, patients' quality of life and prognosis are still poor. Hospitalization for decompensated heart failure or due to other causes is frequent in these patients and places a heavy financial burden on the healthcare system. The shortcomings of ambulatory treatment have led to the implementation of disease management programs whose aim is to optimize quality of care and treatment adherence, thereby improving clinical outcome and prognosis, and reducing healthcare costs. The multicenter randomized DIAL study compared treatment administered by means of a centralized telephone intervention by trained nurses with usual care in 1518 ambulatory patients with stable chronic heart failure who were receiving appropriate medical treatment and were being followed up by a cardiologist. This intervention proved effective in increasing treatment adherence, in reducing hospitalization due to heart failure or any cause, in improving quality of life, and in reducing costs. The findings of the DIAL study add to existing evidence that disease management programs have clinical benefits in patients with chronic heart failure and support their use as part of the strategy for ambulatory care in this population.
尽管在心力衰竭治疗方面取得了重大进展，但患者的生活质量和预后仍然很差。这些患者因失代偿性心力衰竭或其他原因而频繁住院，给医疗系统带来了沉重的经济负担。门诊治疗的不足促使了疾病管理项目的实施，其目的是优化护理质量和治疗依从性，从而改善临床结局和预后，并降低医疗成本。多中心随机DIAL研究将由经过培训的护士通过集中电话干预进行的治疗与1518例接受适当药物治疗且由心脏病专家随访的稳定慢性心力衰竭门诊患者的常规护理进行了比较。该干预措施在提高治疗依从性、减少因心力衰竭或任何原因导致的住院、改善生活质量以及降低成本方面被证明是有效的。DIAL研究的结果进一步证明了疾病管理项目对慢性心力衰竭患者具有临床益处，并支持将其作为该人群门诊护理策略之一加以应用。
