Agvall Björn, Paulsson Thomas, Foldevi Mats, Dahlström Ulf, Alehagen Urban
Department of Medical and Health Sciences, Linkoping University, Department of Primary Health Care, Linkoping, County of Östergötland, Sweden.
Global Health Economics and Outcomes Research, Bristol-Myers Squibb, Belgium.
Int J Cardiol. 2014 Oct 20;176(3):731-8. doi: 10.1016/j.ijcard.2014.07.105. Epub 2014 Aug 2.
Heart failure (HF) is a common but serious condition which involves a significant economic burden on the health care economy. The purpose of this study was to evaluate cost and quality of life (QoL) implications of implementing a HF management program (HFMP) in primary health care (PHC).
This was a prospective randomized open-label study including 160 patients with a diagnosis of HF from five PHC centers in south-eastern Sweden. Patients randomized to the intervention group received information about HF from HF nurses and from a validated computer-based awareness program. HF nurses and physicians followed the patients intensely in order to optimize HF treatment according to current guidelines. The patients in the control group were followed by their regular general practitioner (GP) and received standard treatment according to local management routines. No significant changes were observed in NYHA class and quality-adjusted life years (QALY), implying that functional class and QoL were preserved. However, costs for hospital care (HC) and PHC were reduced by EUR 2167, or 33%. The total cost was EUR 4471 in the intervention group and EUR 6638 in the control group.
Introducing HFMP in Swedish PHC in patients with HF entails a significant reduction in resource utilization and costs, and maintains QoL. Based on these results, a broader implementation of HFMP in PHC may be recommended. However, results should be confirmed with extended follow-up to verify long-term effects.
心力衰竭（HF）是一种常见但严重的疾病，给医疗保健经济带来了巨大的经济负担。本研究的目的是评估在初级卫生保健（PHC）中实施心力衰竭管理计划（HFMP）对成本和生活质量（QoL）的影响。
这是一项前瞻性随机开放标签研究，纳入了瑞典东南部五个初级卫生保健中心的160例确诊为HF的患者。随机分配到干预组的患者从HF护士和经过验证的基于计算机的认知计划中获得有关HF的信息。HF护士和医生密切跟踪患者，以便根据当前指南优化HF治疗。对照组患者由其常规全科医生（GP）随访，并根据当地管理常规接受标准治疗。纽约心脏协会（NYHA）分级和质量调整生命年（QALY）未观察到显著变化，这意味着功能分级和生活质量得以维持。然而，医院护理（HC）和初级卫生保健的成本降低了2167欧元，即33%。干预组的总成本为4471欧元，对照组为6638欧元。
在瑞典初级卫生保健中对HF患者引入HFMP可显著降低资源利用和成本，并维持生活质量。基于这些结果，可能建议在初级卫生保健中更广泛地实施HFMP。然而，结果应通过延长随访进行确认，以验证长期效果。
