Stony Brook University, Stony Brook, NY 11794-8240, USA.
Heart Lung. 2013 Jul-Aug;42(4):273-80. doi: 10.1016/j.hrtlng.2013.03.005. Epub 2013 Apr 25.
The purpose of this study was to test the efficacy of a heart failure (HF) training program on patients' ability to recognize and respond to changes in HF symptoms. The primary aim was to compare event-free survival at 90 days.
A total of 99 HF patients randomized to the HF symptom training intervention or usual care completed instruments about self-care (Self-Care of HF Index) and at baseline and 3 months. Demographic, clinical, and comorbidity data were collected by interview and chart review. Time to first event (death or a HF-related hospitalization) was tracked by electronic records and patient interview.
The sample was predominately male (67.7%), elderly (67.7 yrs ± 12.1) and Caucasian (88.9%). The intervention group reported more events but the difference was not significantly different (χ(2) = 1.18, p = 0.26). There was no difference in survival time between groups (χ(2) = 1.53, p = 0.216). In paired t-tests, the intervention group had significantly improved self-care maintenance, management and confidence scores (all p < 0.01). The usual care group had significantly improved self-care maintenance and management (both p < 0.01). Improvements in self-care maintenance and confidence were higher in the intervention group compared with usual care (18.0 vs. 12.9 points).
HF symptom awareness training appeared to have an early but not sustained benefit resulting in no difference in 90-day event-free survival. However, larger improvement in self-care maintenance and confidence scores in the intervention group compared to usual care is promising. Embedding meaningful symptom monitoring strategies in self-care maintenance interventions requires further investigation.
本研究旨在测试心力衰竭（HF）训练计划对患者识别和应对 HF 症状变化能力的疗效。主要目的是比较 90 天无事件生存率。
共 99 例 HF 患者随机分为 HF 症状训练干预组或常规护理组，在基线和 3 个月时完成自我护理（HF 自我护理指数）和其他相关量表。通过访谈和病历回顾收集人口统计学、临床和合并症数据。通过电子记录和患者访谈跟踪首次事件（死亡或与 HF 相关的住院）发生时间。
样本主要为男性（67.7%）、老年人（67.7 岁±12.1 岁）和白种人（88.9%）。干预组报告的事件更多，但差异无统计学意义（χ²=1.18，p=0.26）。两组的生存时间无差异（χ²=1.53，p=0.216）。在配对 t 检验中，干预组自我护理维持、管理和信心评分均显著提高（均 p<0.01）。常规护理组自我护理维持和管理评分显著提高（均 p<0.01）。与常规护理相比，干预组自我护理维持和信心的改善更高（18.0 分比 12.9 分）。
HF 症状意识训练似乎有早期但不持续的获益，导致 90 天无事件生存率无差异。然而，与常规护理相比，干预组自我护理维持和信心评分的较大改善是有希望的。在自我护理维持干预中嵌入有意义的症状监测策略需要进一步研究。
