N-末端脑利钠肽前体指导的强化患者管理联合多学科治疗对慢性心力衰竭患者的影响：一项 3 臂前瞻性随机对照研究

N-terminal pro-B-type natriuretic peptide-guided, intensive patient management in addition to multidisciplinary care in chronic heart failure a 3-arm, prospective, randomized pilot study.

机构信息

Department of Cardiology, Medical University of Vienna, Vienna, Austria.

出版信息

J Am Coll Cardiol. 2010 Feb 16;55(7):645-53. doi: 10.1016/j.jacc.2009.08.078.

DOI:10.1016/j.jacc.2009.08.078

PMID:20170790

Abstract

OBJECTIVES

This study was designed to investigate whether the addition of N-terminal pro-B-type natriuretic peptide-guided, intensive patient management (BM) to multidisciplinary care (MC) improves outcome in patients following hospitalization due to heart failure (HF).

BACKGROUND

Patients hospitalized due to HF experience frequent rehospitalizations and high mortality.

METHODS

Patients hospitalized due to HF were randomized to BM, MC, or usual care (UC). Multidisciplinary care included 2 consultations from an HF specialist who provided therapeutic recommendations and home care by a specialized HF nurse. In addition, BM included intensified up-titration of medication by HF specialists in high-risk patients. NT-proBNP was used to define the level of risk and to monitor wall stress. This monitoring allowed for anticipation of cardiac decompensation and adjustment of medication in advance.

RESULTS

A total of 278 patients were randomized in 8 Viennese hospitals. After 12 months, the BM group had the highest proportion of antineurohormonal triple-therapy (difference among all groups). Accordingly, BM reduced days of HF hospitalization (488 days) compared with the hospitalization for the MC (1,254 days) and UC (1,588 days) groups (p < 0.0001; significant differences among all groups). Using Kaplan-Meier analysis, the first HF rehospitalization (28%) was lower in the BM versus MC groups (40%; p = 0.06) and the MC versus UC groups (61%; p = 0.01). Moreover, the combined end point of death or HF rehospitalization was lower in the BM (37%) than in the MC group (50%; p < 0.05) and in the MC than in the UC group (65%; p = 0.04). Death rate was similar between the BM (22%) and MC groups (22%), but was lower compared with the UC group (39%; vs. BM: p < 0.02; vs. MC: p < 0.02).

CONCLUSIONS

Compared with MC alone, additional BM improves clinical outcome in patients after HF hospitalization. (BNP Guided Care in Addition to Multidisciplinary Care; NCT00355017).

摘要

目的

本研究旨在探讨在因心力衰竭（HF）住院的患者中，加用 N 端脑利钠肽前体（NT-proBNP）指导的强化患者管理（BM）与多学科护理（MC）相结合是否能改善预后。

背景

因 HF 住院的患者常需再住院且死亡率高。

方法

因 HF 住院的患者被随机分为 BM 组、MC 组或常规护理（UC）组。MC 包括 2 次 HF 专家会诊，提供治疗建议，并由专门的 HF 护士进行家庭护理。此外，BM 组包括 HF 专家对高危患者进行药物强化滴定。NT-proBNP 用于确定风险水平并监测壁面应力。这种监测可以提前预测心脏失代偿并调整药物。

结果

共 278 例患者在维也纳的 8 家医院进行了随机分组。12 个月后，BM 组抗神经激素三联疗法的比例最高（各组间差异最大）。因此，BM 组与 MC 组（1254 天）和 UC 组（1588 天）相比，HF 住院天数（488 天）减少（p<0.0001；各组间差异有统计学意义）。Kaplan-Meier 分析显示，BM 组较 MC 组（40%；p=0.06）和 MC 组较 UC 组（61%；p=0.01）首次 HF 再住院率（28%）更低。此外，BM 组的死亡或 HF 再住院复合终点发生率（37%）低于 MC 组（50%；p<0.05）和 MC 组高于 UC 组（65%；p=0.04）。BM 组（22%）和 MC 组（22%）的死亡率相似，但均低于 UC 组（39%；与 BM 组比较：p<0.02；与 MC 组比较：p<0.02）。