GESICA (Grupo de Estudio en Investigación Clínica en Argentina) Foundation, Buenos Aires 1034, Argentina.
J Am Coll Cardiol. 2010 Jul 27;56(5):372-8. doi: 10.1016/j.jacc.2010.03.049.
The purpose of this study was to assess the rate of death and hospitalization for heart failure (HF) 1 and 3 years after a randomized trial of telephone intervention aimed to improve education and compliance in stable patients with HF ended.
The long-term effects of HF programs are not well known.
In all, 1,518 patients with HF were randomized into the DIAL (Randomized Trial of Phone Intervention in Chronic Heart Failure). After completion of the trial, patients were followed up to 3 years to assess major outcomes. Compliance with diet, weight control, and treatment was evaluated. The effect of the intervention on mortality and HF hospitalizations was assessed using relative risk (RR), relative risk reduction, and Cox proportional hazards model for adjusting by potential confounders.
The rate of death or hospitalization for HF was lower in the intervention group (37.2% vs. 42.6%, RR: 0.81, 95% confidence interval [CI]: 0.69 to 0.96; p = 0.013) 1 and 3 years (55.7% vs. 57.5%, RR: 0.88, 95% CI: 0.77 to 1.00; p = 0.05) after the intervention ended. This benefit was mainly caused by a reduction in admission for HF (28.5% vs. 35.1% after 3 years, RR: 0.72, 95% CI: 0.60 to 0.87; p = 0.0004). Patients who showed improvement in 1 or more of 3 key compliance indicators (diet, weight control, and medication) had lower risks of events.
The benefit observed during the intervention period persisted and was sustained 1 and 3 years after the intervention ended. This effect may be explained by the impact of the educational intervention on patients' behavior and habits.
本研究旨在评估一项旨在改善稳定心力衰竭（HF）患者教育和依从性的电话干预随机试验结束后 1 年和 3 年的死亡率和 HF 住院率。
HF 项目的长期效果尚不清楚。
共有 1518 例 HF 患者被随机分为 DIAL（慢性心力衰竭电话干预随机试验）。试验结束后，对患者进行了 3 年的随访，以评估主要结局。评估了饮食、体重控制和治疗的依从性。使用相对风险（RR）、相对风险降低和 Cox 比例风险模型评估干预对死亡率和 HF 住院的影响，以调整潜在的混杂因素。
干预组的死亡率或 HF 住院率较低（37.2%比 42.6%，RR：0.81，95%置信区间[CI]：0.69 至 0.96；p = 0.013）1 年和 3 年（55.7%比 57.5%，RR：0.88，95%CI：0.77 至 1.00；p = 0.05）干预结束后。这种益处主要是由于 HF 入院率降低（3 年后分别为 28.5%和 35.1%，RR：0.72，95%CI：0.60 至 0.87；p = 0.0004）。在 1 或多个关键依从性指标（饮食、体重控制和药物治疗）中改善的患者发生事件的风险较低。
干预期间观察到的益处在干预结束后 1 年和 3 年持续存在。这种效果可能是由于教育干预对患者行为和习惯的影响。
