Oyanguren Juana, Latorre García Pedro María, Torcal Laguna Jesús, Lekuona Goya Iñaki, Rubio Martín Susana, Maull Lafuente Elena, Grandes Gonzalo
Departamento de Cardiología y Atención Primaria, Organización Sanitaria Integrada Hospital de Galdakao-Comarca Interior, Osakidetza-Servicio Vasco de Salud, Galdácano, Vizcaya, Spain.
Unidad de Investigación de Atención Primaria, Osakidetza-Servicio Vasco de Salud, Vizcaya, Spain.
Rev Esp Cardiol (Engl Ed). 2016 Oct;69(10):900-914. doi: 10.1016/j.rec.2016.05.012.
Heart failure management programs reduce hospitalizations. Some studies also show reduced mortality. The determinants of program success are unknown. The aim of the present study was to update our understanding of the reductions in mortality and readmissions produced by these programs, elucidate their components, and identify the factors determining program success.
Systematic literature review (1990-2014; PubMed, EMBASE, CINAHL, Cochrane Library) and manual search of relevant journals. The studies were selected by 3 independent reviewers. Methodological quality was evaluated in a blinded manner by an external researcher (Jadad scale). These results were pooled using random effects models. Heterogeneity was evaluated with the I statistic, and its explanatory factors were determined using metaregression analysis.
Of the 3914 studies identified, 66 randomized controlled clinical trials were selected (18 countries, 13 535 patients). We determined the relative risks to be 0.88 for death (95% confidence interval [95%CI], 0.81-0.96; P < .002; I, 6.1%), 0.92 for all-cause readmissions (95%CI, 0.86-0.98; P < .011; I, 58.7%), and 0.80 for heart failure readmissions (95%CI, 0.71-0.90; P < .0001; I, 52.7%). Factors associated with program success were implementation after 2001, program location outside the United States, greater baseline use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, a higher number of intervention team members and components, specialized heart failure cardiologists and nurses, protocol-driven education and its assessment, self-monitoring of signs and symptoms, detection of deterioration, flexible diuretic regimen, early care-seeking among patients and prompt health care response, psychosocial intervention, professional coordination, and program duration.
We confirm the reductions in mortality and readmissions with heart failure management programs. Their success is associated with various structural and intervention variables.
心力衰竭管理项目可减少住院次数。一些研究还表明该项目可降低死亡率。项目成功的决定因素尚不清楚。本研究的目的是更新我们对这些项目所带来的死亡率降低和再入院率降低的认识，阐明其组成部分，并确定决定项目成功的因素。
系统文献综述（1990 - 2014年；PubMed、EMBASE、CINAHL、Cochrane图书馆）以及对相关期刊的人工检索。由3名独立评审员筛选研究。一名外部研究人员采用盲法评估方法学质量（Jadad量表）。使用随机效应模型汇总这些结果。用I统计量评估异质性，并通过Meta回归分析确定其解释因素。
在识别出的3914项研究中，选取了66项随机对照临床试验（18个国家，13535例患者）。我们确定死亡的相对风险为0.88（95%置信区间[95%CI]，0.81 - 0.96；P <.002；I，6.1%），全因再入院的相对风险为0.92（95%CI，0.86 - 0.98；P <.011；I，58.7%），心力衰竭再入院的相对风险为0.80（95%CI，0.71 - 0.90；P <.0001；I，52.7%）。与项目成功相关的因素包括2001年后实施、项目地点在美国境外、基线时更大程度地使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、干预团队成员和组成部分数量更多、专业的心力衰竭心脏病专家和护士、方案驱动的教育及其评估、体征和症状的自我监测、病情恶化的检测、灵活的利尿剂方案、患者早期寻求医疗护理以及及时的医疗保健响应、心理社会干预、专业协调和项目持续时间。
我们证实心力衰竭管理项目可降低死亡率和再入院率。其成功与多种结构和干预变量相关。
