Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Eur Heart J. 2012 Nov;33(21):2692-9. doi: 10.1093/eurheartj/ehs071. Epub 2012 Mar 27.
The management of patients with atrial fibrillation (AF) is often inadequate due to deficient adherence to the guidelines. A nurse-led AF clinic providing integrated chronic care to improve guideline adherence and activate patients in their role, may effectively reduce morbidity and mortality but such care has not been tested in a large randomized trial. Therefore, we performed a randomized clinical trial to compare the AF clinic with routine clinical care in patients with AF.
We randomly assigned 712 patients with AF to nurse-led care and usual care. Nurse-led care consisted of guidelines based, software supported integrated chronic care supervised by a cardiologist. The primary endpoint was a composite of cardiovascular hospitalization and cardiovascular death. Duration of follow-up was at least 12 months. Adherence to guideline recommendations was significantly better in the nurse-led care group. After a mean of 22 months, the primary endpoint occurred in 14.3% of 356 patients of the nurse-led care group compared with 20.8% of 356 patients receiving usual care [hazard ratio: 0.65; 95% confidence interval (CI) 0.45-0.93; P= 0.017]. Cardiovascular death occurred in 1.1% in the nurse-led care vs. 3.9% in the usual care group (hazard ratio: 0.28; 95% CI: 0.09-0.85; P= 0.025). Cardiovascular hospitalization amounted (13.5 vs. 19.1%, respectively, hazard ratio: 0.66; 95% CI: 0.46-0.96, P= 0.029).
Nurse-led care of patients with AF is superior to usual care provided by a cardiologist in terms of cardiovascular hospitalizations and cardiovascular mortality. Trial registration information: Clinicaltrials.gov identifier number: NCT00391872.
由于对指南的遵从性不足，心房颤动（AF）患者的管理往往不够完善。一个由护士主导的房颤诊所提供综合的慢性护理，以改善对指南的遵从性并激活患者的角色，可能会有效地降低发病率和死亡率，但这种护理尚未在大型随机试验中得到检验。因此，我们进行了一项随机临床试验，比较房颤诊所与房颤患者的常规临床护理。
我们将 712 名房颤患者随机分配到护士主导的护理和常规护理组。护士主导的护理包括基于指南、软件支持的综合慢性护理，由心脏病专家监督。主要终点是心血管住院和心血管死亡的复合终点。随访时间至少为 12 个月。护士主导的护理组对指南建议的遵从性显著提高。在平均 22 个月后，护士主导的护理组的 356 名患者中有 14.3%发生了主要终点事件，而接受常规护理的 356 名患者中有 20.8%发生了主要终点事件[风险比：0.65；95%置信区间（CI）0.45-0.93；P=0.017]。在护士主导的护理组中，心血管死亡发生在 1.1%的患者中，而在常规护理组中则为 3.9%（风险比：0.28；95%CI：0.09-0.85；P=0.025）。心血管住院治疗分别为（13.5 对 19.1%，风险比：0.66；95%CI：0.46-0.96，P=0.029）。
在心血管住院治疗和心血管死亡率方面，护士主导的房颤患者护理优于心脏病专家提供的常规护理。
Clinicaltrials.gov 标识符号：NCT00391872。
