Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España; Grupo de investigación en Comorbilidad y Pluripatología en Aragón, Instituto Aragonés de Ciencias de la Salud, Zaragoza, España; Departamento de Medicina, Dermatología y Psiquiatría, Universidad de Zaragoza, Zaragoza, España.
Servicio de Medicina Interna, Hospital Vall d'Hebron, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
Med Clin (Barc). 2017 Sep 20;149(6):240-247. doi: 10.1016/j.medcli.2017.02.023. Epub 2017 Apr 7.
To determine the effectiveness of a simple educational intervention to improve the management of cardiovascular comorbidities in patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (COPD).
Multicenter study participated in by 26 hospital centers. A panel of experts elaborated a set of recommendations about diagnostic and therapeutic management of acute exacerbation of COPD and cardiovascular comorbidities (coronary artery disease, atrial fibrillation, heart failure and diabetes). The recommendations were graduated as indispensable, advisable and outstanding. Compliance with recommendations were assessed in the discharge letter for COPD patients hospitalized with acute exacerbation in Internal Medicine departments. The protocols to treat the comorbidities in COPD were explained in a clinical session. After 6 months' compliance with recommendations they were reassessed.
A total of 390 cases before and after the intervention were assessed. There was significant progress in 53% of cases. The improvement was greater in cases referred to general management and COPD management (66.7 and 76.9%, respectively), and lower in cases referred to ischemic heart disease (11.1%) and none in those referred to coronary artery disease. After the intervention, the adherence to overall and indispensable recommendations was higher (P=.020 and P=.017, respectively) and a trend to improve was observed in advisable (P=.058) and outstanding recommendations (P=.063).
A simple intervention can improve the management of lung disease in COPD patients with an acute exacerbation, but has less effect on the management of comorbidities.
确定一项简单的教育干预措施在改善慢性阻塞性肺疾病（COPD）急性加重期患者心血管合并症管理方面的有效性。
本研究为多中心研究，参与单位为 26 家医院。一组专家制定了一套关于 COPD 急性加重和心血管合并症（冠状动脉疾病、心房颤动、心力衰竭和糖尿病）的诊断和治疗管理的建议。建议分为必要、适当和突出。在呼吸内科住院的 COPD 急性加重患者的出院记录中评估对建议的依从性。在临床会议中解释了 COPD 合并症的治疗方案。在遵循建议 6 个月后重新评估。
共评估了干预前 390 例和干预后 390 例。53%的病例有显著进展。在一般治疗和 COPD 管理方面的改善更大（分别为 66.7%和 76.9%），而在缺血性心脏病方面的改善较小（11.1%），在冠状动脉疾病方面则没有改善。干预后，整体和必要建议的依从性更高（P=.020 和 P=.017），适当和突出建议的依从性也呈改善趋势（P=.058 和 P=.063）。
简单的干预可以改善 COPD 急性加重患者的肺部疾病管理，但对合并症的管理效果较小。
