Jakobsson Stina, Irewall Anna-Lotta, Bjorklund Fredrik, Mooe Thomas
Department of Public Health and Clinical Medicine, Division of Medicine, Ostersund sjukhus, Umea University, Umea, Sweden.
BMC Cardiovasc Disord. 2015 Oct 14;15:125. doi: 10.1186/s12872-015-0115-0.
Enhanced cardiovascular secondary preventive follow-up is needed to improve adherence to recommended low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) levels. Patients with diabetes mellitus (DM) or chronic kidney disease (CKD) have a high risk of recurrent events. Secondary prevention is therefore essential in these patients.
Patients with acute coronary syndrome, stroke, or transient ischemic attack were randomized to nurse-based telephone follow-up (intervention) or usual care (control). LDL-C and BP were measured at 1 month (baseline) and 12 months post-discharge. Intervention patients with above-target values at baseline received medication titration to achieve treatment goals. Values measured for control patients were given to the patient's general practitioner for assessment.
The final analyses included 225 intervention and 215 control patients with DM or CKD. Among patients with above-target baseline values, the following 12-month values were recorded for intervention and control patients, respectively: LDL-C, 2.2 versus 3.0 mmol/L (p < 0.001); and median systolic BP (SBP), 140 versus 145 mmHg (p = 0.26). Among patients with above-target values at baseline, 52.3 % of intervention patients reached target LDL-C values at 12 months versus 21.3 % of control patients (absolute difference of 30.9 %, 95 % CI 16.1 to 43.8 %), and there was a non-significant trend of more intervention patients reaching target SBP (49.4 % versus 36.8 %; absolute difference of 12.6 %, 95 % CI -1.7 to 26.2 %).
Cardiovascular secondary prevention with nurse-based telephone follow-up was more effective than usual care in improving LDL-C levels 12 months after discharge for patients with DM or CKD.
ISRCTN registry; ISRCTN96595458 (date of registration 10 July 2011) and ISRCTN23868518 (date of registration 13 May 2012).
需要加强心血管疾病二级预防随访，以提高对推荐的低密度脂蛋白胆固醇（LDL-C）和血压（BP）水平的依从性。糖尿病（DM）或慢性肾脏病（CKD）患者复发事件风险高。因此，二级预防对这些患者至关重要。
将急性冠状动脉综合征、中风或短暂性脑缺血发作患者随机分为基于护士的电话随访组（干预组）或常规治疗组（对照组）。在出院后1个月（基线）和12个月时测量LDL-C和BP。基线时LDL-C和BP值高于目标值的干预组患者接受药物滴定以实现治疗目标。将对照组患者测量的值提供给其全科医生进行评估。
最终分析纳入了225例干预组和215例患有DM或CKD的对照组患者。在基线值高于目标值的患者中，干预组和对照组患者12个月时的以下值分别为：LDL-C，2.2 mmol/L对3.0 mmol/L（p<0.001）；收缩压（SBP）中位数，140 mmHg对145 mmHg（p = 0.26）。在基线值高于目标值的患者中，12个月时52.3%的干预组患者达到LDL-C目标值，而对照组患者为21.3%（绝对差异为30.9%，95%CI为16.1%至43.8%），且干预组更多患者达到SBP目标值的趋势不显著（49.4%对36.8%；绝对差异为12.6%，95%CI为-1.7%至26.2%）。
对于患有DM或CKD的患者，出院后12个月时，基于护士的电话随访进行心血管疾病二级预防在改善LDL-C水平方面比常规治疗更有效。
ISRCTN注册库；ISRCTN96595458（注册日期2011年7月10日）和ISRCTN23868518（注册日期2012年5月13日）。
