护士主导诊所对心血管疾病患者死亡率和发病率的影响：一项系统评价与荟萃分析。
The Impact of Nurse-Led Clinics on the Mortality and Morbidity of Patients with Cardiovascular Diseases: A Systematic Review and Meta-analysis.
作者信息
Al-Mallah Mouaz H, Farah Iyad, Al-Madani Wedad, Bdeir Bassam, Al Habib Samia, Bigelow Maureen L, Murad Mohammad Hassan, Ferwana Mazen
机构信息
Mouaz H. Al-Mallah, MD, MSc, FACC, FAHA, FESC King Saud Bin Abdulaziz University for Health Sciences; Associate Professor of Medicine, Consultant Cardiologist, King Abdulaziz Cardiac Center, King Abdulaziz Medical City; and National and Gulf Center for Evidence Based Health Practice, Riyadh, KSA. Iyad Farah, RN Nurse Specialist, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Riyadh, KSA. Wedad Al-Madani, MSc King Saud Bin Abdulaziz University for Health Sciences; and Coordinator, National and Gulf Center for Evidence Based Health Practice, Riyadh, KSA. Bassam Bdeir, MD King Saud Bin Abdulaziz University for Health Sciences; and Director Cardiac Clinics and Cardiovascular Disease Management Program, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Riyadh, KSA. Samia Al Habib, MD, PhD King Saud Bin Abdulaziz University for Health Sciences; Family Medicine and Primary Health Care Department, King Abdelaziz Medical City; and National and Gulf Center for Evidence Based Health Practice, Riyadh, KSA. Maureen L. Bigelow, RN Assistant Professor of Nursing, Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota. Mohammad Hassan Murad, MD, MPH Professor of Medicine, Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota. Mazen Ferwana, MD, PhD King Saud Bin Abdulaziz University for Health Sciences; Family Medicine and Primary Health Care Department, King Abdelaziz Medical City; and National and Gulf Center for Evidence Based Health Practice, Riyadh, KSA.
出版信息
J Cardiovasc Nurs. 2016 Jan-Feb;31(1):89-95. doi: 10.1097/JCN.0000000000000224.
BACKGROUND
Nurse-led clinics (NLCs) have been developed in several health specialties in recent years. The aim of this analysis is to summarize and appraise the available evidence about the effectiveness of NLCs on the morbidity and mortality outcomes in patients with cardiovascular diseases (CVDs).
METHODS
We searched Cochrane databases, MEDLINE, Web of Science, PubMed, EMBASE, Google Scholar, BIOSIS, and bibliography of secondary sources from inception through February 20, 2013. Studies were selected and data were extracted independently by 2 investigators. Eligible studies were randomized trials of NLCs of patients with CVD. Of 56 potentially relevant articles screened initially, 12 trials met the inclusion criteria. The outcomes of interest were all-cause mortality, cardiovascular mortality, nonfatal myocardial infarction, major adverse cardiac events, revascularization, lipids control, and adherence to antiplatelet medications. We performed random-effects meta-analysis to estimate summary risk ratios and quantified between-studies heterogeneity with the I2 statistic.
RESULTS
The 12 trials allocated 4886 patients to NLCs and 4954 patients to usual care. The NLC patients had decreased all-cause mortality (odds ratio, 0.78; 95% confidence interval [CI], 0.65-0.95; P < .01) and myocardial infarction (odds ratio, 0.63; 95% CI, 0.39-1.00; P = .05) and had higher adherence to lipid-lowering medication (odds ratio, 1.57; 95% CI, 1.14-2.17; P = .006) compared with controls. They also had increased adherence to antiplatelet therapy compared with controls (odds ratio, 1.42; 95% CI, 1.01-1.98; P = .04). There was no statistically significant difference in the risk of cardiovascular death (odds ratio, 0.68; 95% CI, 0.40-1.15; P = .68), major adverse cardiac events (odds ratio, 0.79; 95% CI, 0.55-1.14; P = .21),or revascularization (odds ratio, 0.87; 95% CI, 0.66-1.16; P = .36) between NLC patients and controls.
CONCLUSIONS
The available evidence suggests a favorable effect of NLCs on all-cause mortality, rate of major adverse cardiac events, and adherence to medications in patients with CVD.
背景
近年来，护士主导的诊所（NLCs）已在多个健康专业领域得到发展。本分析的目的是总结和评估关于NLCs对心血管疾病（CVDs）患者发病率和死亡率影响的现有证据。
方法
我们检索了Cochrane数据库、MEDLINE、科学网、PubMed、EMBASE、谷歌学术、BIOSIS以及截至2013年2月20日的二次文献书目。研究由2名研究人员独立选择并提取数据。符合条件的研究是针对CVD患者的NLCs随机试验。在最初筛选的56篇潜在相关文章中，12项试验符合纳入标准。感兴趣的结局包括全因死亡率、心血管死亡率、非致命性心肌梗死、主要不良心脏事件、血运重建、血脂控制以及抗血小板药物的依从性。我们进行随机效应荟萃分析以估计汇总风险比，并使用I2统计量量化研究间的异质性。
结果
12项试验将4886例患者分配至NLCs组，4954例患者分配至常规治疗组。与对照组相比，NLCs组患者的全因死亡率降低（优势比，0.78；95%置信区间[CI]，0.65 - 0.95；P <.01），心肌梗死发生率降低（优势比，0.63；95% CI，0.39 - 1.00；P =.05），并且降脂药物依从性更高（优势比，1.57；95% CI，1.14 - 2.17；P =.006）。与对照组相比，他们的抗血小板治疗依从性也有所提高（优势比，1.42；95% CI，1.01 - 1.98；P =.04）。NLCs组患者与对照组在心血管死亡风险（优势比，0.68；95% CI，0.40 - 1.15；P =.68）、主要不良心脏事件（优势比，0.79；95% CI，0.55 - 1.14；P =.21）或血运重建（优势比，0.87；95% CI，0.66 - 1.16；P =.36）方面无统计学显著差异。
结论
现有证据表明NLCs对CVD患者的全因死亡率、主要不良心脏事件发生率和药物依从性有积极影响。
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