Kirchberger Inge, Hunger Matthias, Stollenwerk Björn, Seidl Hildegard, Burkhardt Katrin, Kuch Bernhard, Meisinger Christa, Holle Rolf
Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany.
Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
PLoS One. 2015 Mar 26;10(3):e0116693. doi: 10.1371/journal.pone.0116693. eCollection 2015.
Home-based secondary prevention programs led by nurses have been proposed to facilitate patients' adjustment to acute myocardial infarction (AMI). The objective of this study was to conduct secondary analyses of the three-year follow-up of a nurse-based case management for elderly patients discharged from hospital after an AMI.
In a single-centre randomized two-armed parallel group trial of hospitalized patients with AMI ≥65 years, patients hospitalized between September 2008 and May 2010 in the Hospital of Augsburg, Germany, were randomly assigned to case management or usual care. The case-management intervention consisted of a nurse-based follow-up for three years including home visits and telephone calls. Study endpoints were time to first unplanned readmission or death, clinical parameters, functional status, depressive symptoms and malnutrition risk. Persons who assessed three-year outcomes and validated readmission data were blinded. The intention-to-treat approach was applied to the statistical analyses which included Cox Proportional Hazards models.
Three hundred forty patients were allocated to receive case-management (n = 168) or usual care (n = 172). During three years, in the intervention group there were 80 first unplanned readmissions and 6 deaths, while the control group had 111first unplanned readmissions and 3 deaths. The intervention did not significantly affect time to first unplanned readmission or death (Hazard Ratio 0.89, 95% confidence interval (CI) 0.67-1.19; p = 0.439), blood pressure, cholesterol level, instrumental activities of daily life (IADL) (only for men), and depressive symptoms. However, patients in the intervention group had a significantly better functional status, as assessed by the HAQ Disability Index, IADL (only for women), and hand grip strength, and better SCREEN-II malnutrition risk scores than patients in the control group.
A nurse-based management among elderly patients with AMI did not significantly affect time to unplanned readmissions or death during a three-year follow-up. However, the results indicate that functional status and malnutrition risk can be improved.
Current Controlled Trials ISRCTN02893746.
由护士主导的居家二级预防项目被提议用于促进急性心肌梗死（AMI）患者适应疾病。本研究的目的是对一项针对AMI后出院的老年患者的基于护士的病例管理进行三年随访的二次分析。
在一项针对年龄≥65岁的住院AMI患者的单中心随机双臂平行组试验中，2008年9月至2010年5月期间在德国奥格斯堡医院住院的患者被随机分配至病例管理组或常规护理组。病例管理干预包括由护士进行为期三年的随访，包括家访和电话随访。研究终点为首次非计划再入院或死亡时间、临床参数、功能状态、抑郁症状和营养不良风险。评估三年结局和验证再入院数据的人员均为盲法。意向性分析方法应用于包括Cox比例风险模型的统计分析。
340名患者被分配接受病例管理（n = 168）或常规护理（n = 172）。三年间，干预组有80例首次非计划再入院和6例死亡，而对照组有111例首次非计划再入院和3例死亡。该干预对首次非计划再入院或死亡时间（风险比0.89，95%置信区间（CI）0.67 - 1.19；p = 0.439）、血压、胆固醇水平、日常生活工具性活动（IADL）（仅针对男性）和抑郁症状无显著影响。然而，通过健康评估问卷残疾指数、IADL（仅针对女性）和握力评估，干预组患者的功能状态明显优于对照组患者，且营养不良风险筛查-II评分也更好。
在老年AMI患者中，基于护士的管理在三年随访期间对非计划再入院或死亡时间无显著影响。然而，结果表明功能状态和营养不良风险可以得到改善。
当前受控试验ISRCTN02893746。
