Department of Family Medicine, Medical Academy of Postgraduate Studies, Saint Petersburg, Russia.
Eur J Gen Pract. 2010 Dec;16(4):205-14. doi: 10.3109/13814788.2010.527938.
Disease management programmes (DMPs) improve quality of care for patients with heart failure (HF). However, only a limited number of trials have studied the efficacy of such programmes for patients with heart failure with preserved ejection fraction (HFPEF).
To estimate the impact of a structured, nurse-led patient education programme and care plan in general practice on outcome parameters and events in patients with HFPEF.
Single blinded randomized clinical trial with an intervention over six months and a follow-up during 12 additional months. In the control group, the patients (n = 41) were managed according to Russian national guidelines. Patients in the intervention group (n = 44) received education on individual lifestyle changes and modifications of cardiovascular disease (CVD) risk factors, home-based exercise training and weekly nurse consultations in addition to usual care.
Six months after their inclusion, patients in the intervention group significantly improved body mass index, waist circumference, six-min walk test distance, total cholesterol, low-density lipoprotein, left ventricular end-diastolic volume index, quality of life and level of anxiety. After 18 months, there were 11 deaths (25%) or hospitalizations in the intervention group and 12 (29%) in the control group (P = 0.134). Cardiovascular mortality and readmission rate were not reduced significantly after six months of follow-up: the hazard ratio was 0.47 (95% CI: 0.17-1.28; P = 0.197). After 18 months, this was 0.85 (0.42-1.73; P = 0.658).
This primary care based DMP for patients with HFPEF improved the patients' emotional status and quality of life, positively influenced body weight, functional capacity and lipid profile, and attenuated heart remodelling.
疾病管理方案（DMP）可改善心力衰竭（HF）患者的护理质量。然而，仅有有限数量的试验研究了此类方案对射血分数保留的心力衰竭（HFPEF）患者的疗效。
评估在一般实践中，由护士主导的患者教育计划和护理计划对 HFPEF 患者的结局参数和事件的影响。
单盲随机临床试验，干预持续六个月，随访十二个月。在对照组中，患者（n=41）按照俄罗斯国家指南进行管理。干预组患者（n=44）除了常规护理外，还接受了个体生活方式改变和心血管疾病（CVD）危险因素调整、家庭运动训练和每周护士咨询方面的教育。
纳入后六个月，干预组患者的体重指数、腰围、六分钟步行试验距离、总胆固醇、低密度脂蛋白、左心室舒张末期容积指数、生活质量和焦虑水平显著改善。18 个月后，干预组有 11 例死亡（25%）或住院（n=11），对照组有 12 例（29%）（P=0.134）。六个月随访后，心血管死亡率和再入院率没有显著降低：风险比为 0.47（95%CI：0.17-1.28；P=0.197）。18 个月后，这一比值为 0.85（0.42-1.73；P=0.658）。
针对 HFPEF 患者的这种基于初级保健的 DMP 改善了患者的情绪状态和生活质量，对体重、功能能力和血脂谱产生了积极影响，并减轻了心脏重构。
