From the University of California San Francisco, School of Nursing, San Francisco (K.D., S.M.P., S.R.); University of Kentucky, College of Nursing, Lexington (D.K.M.); University of Nevada, Reno (M.M.P.); University of California, School of Medicine, Davis (T.S.N., J.S.); and National Heart, Lung and Blood Institute, Bethesda, MD (L.S.C.).
Circulation. 2014 Jul 15;130(3):256-64. doi: 10.1161/CIRCULATIONAHA.113.003542. Epub 2014 May 9.
Patients with heart failure (HF) who live in rural areas have less access to cardiac services than patients in urban areas. We conducted a randomized, clinical trial to determine the impact of an educational intervention on the composite end point of HF rehospitalization and cardiac death in this population.
Patients (n=602; age, 66±13 years; 41% female; 51% with systolic HF) were randomized to 1 of 3 groups: control (usual care), Fluid Watchers LITE, or Fluid Watchers PLUS. Both intervention groups included a face-to-face education session delivered by a nurse focusing on self-care. The LITE group received 2 follow-up phone calls, whereas the PLUS group received biweekly calls (mean, 5.3±3.6; range, 1-19) until the nurse judged the patient to be adequately trained. Over 2 years of follow-up, 35% of patients (n=211) experienced cardiac death or hospitalization for HF, with no difference among the 3 groups in the proportion who experienced the combined clinical outcome (P=0.06). Although patients in the LITE group had reduced cardiac mortality compared with patients in the control group over the 2 years of follow-up (7.5% and 17.7%, respectively; P=0.003), there was no significant difference in cardiac mortality between patients in the PLUS group and the control group.
A face-to-face education intervention did not significantly decrease the combined end point of cardiac death or hospitalization for HF. Increasing the number of contacts between the patient and nurse did not significantly improve outcome.
http://www.clinicaltrials.gov. Unique identifier: NCT00415545.
与城市地区的患者相比，居住在农村地区的心力衰竭（HF）患者获得心脏服务的机会较少。我们进行了一项随机临床试验，以确定教育干预对该人群中心力衰竭再住院和心脏死亡复合终点的影响。
患者（n=602；年龄 66±13 岁；41%为女性；51%为收缩性 HF）被随机分为 3 组：对照组（常规护理）、Fluid Watchers LITE 组或 Fluid Watchers PLUS 组。两个干预组都包括由护士进行的一次面对面的教育会议，重点是自我护理。LITE 组接受了 2 次后续电话随访，而 PLUS 组则每两周（平均 5.3±3.6；范围 1-19）进行一次电话随访，直到护士认为患者接受了充分的培训。在 2 年的随访期间，35%的患者（n=211）经历了心脏死亡或心力衰竭住院，3 组之间经历联合临床结局的比例没有差异（P=0.06）。尽管 LITE 组的患者在 2 年的随访期间心脏死亡率低于对照组（分别为 7.5%和 17.7%；P=0.003），但 PLUS 组与对照组之间的心脏死亡率没有显著差异。
面对面的教育干预并没有显著降低心力衰竭死亡或住院的复合终点。增加患者与护士之间的联系次数并没有显著改善结果。
