Gallagher Robyn, Sullivan Anne, Hales Susan, Gillies Geraldine, Burke Rhonda, Tofler Geoffrey
Chronic and Complex Care, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, New South Wales, Australia.
Int J Nurs Pract. 2012 Apr;18(2):133-9. doi: 10.1111/j.1440-172X.2012.02010.x.
This study investigated the symptom patterns and duration and associated predictors occurring prior to first heart failure (HF) admission. Data from the Managing Cardiac Function (MACARF) program from January to December 2007 were reviewed in relation to preadmission symptoms and contacts with health professionals. Patients (n = 242) were aged 78.7 years (SD 12 years), male (54%) and married (45%). Patients experienced up to seven symptoms (Mean 2.7, SD 1.4) for a median of 4.47 days (range 1-7) before admission, most commonly increased dyspnoea on exertion (88%), and for the shortest duration chest discomfort. Less than half (48%) contacted a health professional before hospitalization, most often a general practitioner (37%). The duration patients experienced before presenting to hospital was increased if they presented during business hours (beta = 2.68) or the evening (beta = 1.88) (and therefore less from midnight to 8:30 am), or with a change in symptom (beta = 1.4), whereas duration was reduced by chest discomfort (beta = -2.01) and older age (beta = -0.07). There is a significant time window during which patients and health professionals may detect and act on worsening HF symptoms. Newly diagnosed patients with HF need support to recognize and respond to these symptoms to avoid hospital admission.
本研究调查了首次心力衰竭（HF）入院前出现的症状模式、持续时间及相关预测因素。回顾了2007年1月至12月心脏功能管理（MACARF）项目中与入院前症状及与医疗专业人员接触情况相关的数据。患者（n = 242）年龄为78.7岁（标准差12岁），男性占54%，已婚占45%。患者入院前经历多达7种症状（平均2.7种，标准差1.4种），中位持续时间为4.47天（范围1 - 7天），最常见的是运动时呼吸困难加重（88%），持续时间最短的是胸部不适。不到一半（48%）的患者在住院前联系过医疗专业人员，最常联系的是全科医生（37%）。如果患者在工作时间（β = 2.68）或晚上（β = 1.88）（因此从午夜到上午8:30之间就诊的时间更短）就诊，或者症状有变化（β = 1.4），那么他们在就诊前经历症状的持续时间会增加，而胸部不适（β = -2.01）和年龄较大（β = -0.07）则会使持续时间缩短。在患者和医疗专业人员可检测到心力衰竭症状恶化并采取行动方面，存在一个显著的时间窗口。新诊断的心力衰竭患者需要得到支持，以识别并应对这些症状，避免入院治疗。
