Soran Ozlem Z, Piña Ileana L, Lamas Gervasio A, Kelsey Sheryl F, Selzer Faith, Pilotte John, Lave Judith R, Feldman Arthur M
Cardiovascular Institute, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA 15213, USA.
J Card Fail. 2008 Nov;14(9):711-7. doi: 10.1016/j.cardfail.2008.06.448. Epub 2008 Aug 9.
Prior studies suggest that disease management programs may be effective in improving clinical outcomes in patients with heart failure (HF). However, the use of these programs in settings with limited sources and among diverse population is not know. Thus the present study was designed to assess the impact of a computer-based home disease management program (Alere DayLink HF Monitoring System [HFMS]) on the clinical outcomes of Medicare beneficiaries with HF who were elderly, women, and non-white males who received the care from a community-based primary care practitioner.
The Heart Failure Home Care (HFHC) trial was a multicenter, randomized, controlled trial of HFMS versus standard heart failure care (SC: enhanced patient education, education to clinicians, and follow-up). The primary study end point was treatment failure, defined as a composite of cardiovascular death or rehospitalization for heart failure within 6 months of enrollment. Among patients rehospitalized for HF, length of hospital stay was also considered a primary end point. A total of 315 patients were randomized: 160 to HFMS and 155 to SC. Although the incidence of the primary outcome was somewhat higher in the SC arm (28.8% versus 21.2%, P = .15), the difference was not statistically different. The length of hospital stay was also similar in both groups.
Our study results suggest that enhanced patient education and follow-up is as successful as a sophisticated home monitoring device with an interactive program in patients with HF who are elderly, women and non-Caucasian males and receive the care from a community-based primary care practitioner.
先前的研究表明，疾病管理项目可能有助于改善心力衰竭（HF）患者的临床结局。然而，在资源有限的环境以及不同人群中使用这些项目的情况尚不清楚。因此，本研究旨在评估基于计算机的家庭疾病管理项目（Alere DayLink HF监测系统[HFMS]）对老年、女性以及接受社区初级保健医生护理的非白人男性医疗保险受益人心力衰竭患者临床结局的影响。
心力衰竭家庭护理（HFHC）试验是一项多中心、随机对照试验，比较HFMS与标准心力衰竭护理（SC：强化患者教育、对临床医生的教育以及随访）。主要研究终点是治疗失败，定义为入组后6个月内心血管死亡或因心力衰竭再次住院的复合情况。在因心力衰竭再次住院的患者中，住院时间也被视为主要终点。共有315名患者被随机分组：160名接受HFMS，155名接受SC。虽然SC组主要结局的发生率略高（28.8%对21.2%，P = 0.15），但差异无统计学意义。两组的住院时间也相似。
我们的研究结果表明，对于老年、女性以及非白人男性且接受社区初级保健医生护理的心衰患者，强化患者教育和随访与配备交互式程序的先进家庭监测设备一样成功。
