Unverzagt Susanne, Meyer Gabriele, Mittmann Susanne, Samos Franziska-Antonia, Unverzagt Malte, Prondzinsky Roland
Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle- Wittenberg, Halle (Saale), Institute of Health and Nursing Sciences, Martin-Luther-University Halle- Wittenberg, Halle (Saale), Asklepios Parkklinik Bad Salzungen, Carl-von-Basedow-Klinikum Saalekreis GmbH.
Dtsch Arztebl Int. 2016 Jun 24;113(25):423-30. doi: 10.3238/arztebl.2016.0423.
Despite improved treatment options, heart failure remains the third most common cause of death in Germany and the most common reason for hospitalization. The treatment recommendations contained in the relevant guidelines have been incompletely applied in practice. The goal of this systematic review is to study the efficacy of adherence-promoting interventions for patients with heart failure with respect to the taking of medications, the implementation of recommended lifestyle changes, and the improvement in clinical endpoints.
We performed a meta-analysis of pertinent publications retrieved by a systematic literature search.
55 randomized controlled trials were identified, in which a wide variety of interventions were carried out on heterogeneous patient groups with varying definitions of adherence. These trials included a total of 15 016 patients with heart failure who were cared for as either inpatients or outpatients. The efficacy of interventions to promote adherence to drug treatment was studied in 24 trials; these trials documented improved adherence in 10% of the patients overall (95% confidence interval [CI]: [5; 15]). The efficacy of interventions to promote adherence to lifestyle recommendations was studied in 42 trials; improved adherence was found in 31 trials. Improved adherence to at least one recommendation yielded a long-term absolute reduction in mortality of 2% (95% CI: [0; 4]) and a 10% reduction in the likelihood of hospitalization within 12 months of the start of the intervention (95% CI: [3; 17]).
Many effective interventions are available that can lead to sustained improvement in patient adherence and in clinical endpoints. Longterm success depends on patients' assuming responsibility for their own health and can be achieved with the aid of coordinated measures such as patient education and regular follow-up contacts.
尽管治疗方案有所改进，但心力衰竭仍是德国第三大常见死因，也是住院的最常见原因。相关指南中的治疗建议在实践中并未得到充分应用。本系统评价的目的是研究促进心力衰竭患者坚持治疗的干预措施在药物服用、推荐生活方式改变的实施以及临床终点改善方面的疗效。
我们对通过系统文献检索获得的相关出版物进行了荟萃分析。
共纳入55项随机对照试验，这些试验对异质性患者群体进行了多种干预，且对依从性的定义各不相同。这些试验共纳入了15016例心力衰竭患者，他们接受住院或门诊治疗。24项试验研究了促进药物治疗依从性的干预措施的疗效；这些试验记录显示，总体上10%的患者依从性有所提高（95%置信区间[CI]：[5；15]）。42项试验研究了促进生活方式建议依从性的干预措施的疗效；31项试验发现依从性有所提高。至少对一项建议的依从性提高使死亡率长期绝对降低2%（95%CI：[0；4]），干预开始后12个月内住院可能性降低10%（95%CI：[3；17]）。
有许多有效的干预措施可导致患者依从性和临床终点持续改善。长期成功取决于患者对自身健康负责，并可通过患者教育和定期随访等协调措施实现。
