射血分数保留的心力衰竭患者教育计划的效果：使用倾向评分匹配的 ODIN 队列研究结果。

Effectiveness of a patient education programme in heart failure with preserved ejection fraction: Results from the ODIN cohort study using propensity score matching.

机构信息

Inserm, CIC-1433 épidemiologie clinique, épidémiologie et évaluation cliniques, hôpitaux de Brabois, université de Lorraine, CHRU de Nancy, allée du Morvan, 54500 Vandoeuvre-lès-Nancy, France; Université de Lorraine, université Paris-Descartes, Apemac, EA 4360, Nancy, France.

出版信息

Arch Cardiovasc Dis. 2018 Jan;111(1):5-16. doi: 10.1016/j.acvd.2017.03.010. Epub 2017 Sep 22.

DOI:10.1016/j.acvd.2017.03.010

PMID:28943262

Abstract

BACKGROUND

Patient education programmes (PEP) are recommended for patients with heart failure but have not been specifically assessed in heart failure with preserved ejection fraction (HFpEF).

AIM

To assess the effectiveness of a structured PEP in reducing all-cause mortality in patients with HFpEF.

METHODS

Patients with HFpEF were selected from the ODIN cohort, designed to assess PEP effectiveness in patients with HF whatever their ejection fraction, included from 2007 to 2010, and followed up until 2013. Baseline sociodemographic, clinical, biological and therapeutic characteristics were collected. At inclusion, patients were invited to participate in the PEP, which consisted of educational diagnosis, education sessions and final evaluation. Education focused on HF pathophysiology and medication, symptoms of worsening HF, dietary recommendations and management of exercise. Propensity score matching and Cox models were performed.

RESULTS

Of 849 patients with HFpEF, 572 (67.4%) participated in the PEP and 277 (32.6%) did not. Patients who participated in the PEP were younger (67.0±13.1 vs 76.1±13.2 years; standardized difference [StDiff] =-54.6%), less often women (39.7% vs 48.4%; StDiff =-17.6%) and presented more often with hypercholesterolaemia (55.2% vs 35.2%; StDiff 41.2%), smoking (35.1% vs 28.7%; StDiff 13.8%), alcohol abuse (14.1% vs 8.9%; StDiff 16.5%) and ischaemic HF (38.7% vs 29.2%; StDiff 20.0%) than those who did not; they also presented with better clinical cardiovascular variables. After propensity score matching, baseline characteristics were balanced, except hypertension (postmatch StDiff 19.1%). The PEP was associated with lower all-cause mortality (pooled hazard ratio 0.70, 95% confidence interval 0.49-0.99; P=0.042). This association remained significant after adjustment for hypertension (adjusted pooled hazard ratio 0.68, 95% confidence interval 0.48-0.97; P=0.036).

CONCLUSIONS

In this investigation, a structured PEP was associated with lower all-cause mortality. Patient education might be considered an effective treatment in patients with HFpEF.

摘要

背景

患者教育计划（PEP）被推荐用于心力衰竭患者，但尚未在射血分数保留的心力衰竭（HFpEF）患者中进行专门评估。

目的

评估结构化 PEP 在降低 HFpEF 患者全因死亡率方面的有效性。

方法

从 2007 年至 2010 年入选的旨在评估无论射血分数如何的心力衰竭患者中 PEP 有效性的 ODIN 队列中选择 HFpEF 患者，并随访至 2013 年。收集基线社会人口统计学、临床、生物学和治疗特征。纳入时，邀请患者参加 PEP，该计划包括教育诊断、教育课程和最终评估。教育侧重于心力衰竭病理生理学和药物治疗、心力衰竭恶化的症状、饮食建议和运动管理。进行倾向评分匹配和 Cox 模型分析。

结果

在 849 名 HFpEF 患者中，572 名（67.4%）参加了 PEP，277 名（32.6%）未参加。参加 PEP 的患者年龄较小（67.0±13.1 岁 vs 76.1±13.2 岁；标准化差异 [StDiff] =-54.6%），女性比例较低（39.7% vs 48.4%；StDiff =-17.6%），更常患有高胆固醇血症（55.2% vs 35.2%；StDiff 41.2%）、吸烟（35.1% vs 28.7%；StDiff 13.8%）、酗酒（14.1% vs 8.9%；StDiff 16.5%）和缺血性心力衰竭（38.7% vs 29.2%；StDiff 20.0%）；他们的临床心血管变量也更好。在进行倾向评分匹配后，基线特征得到平衡，除了高血压（匹配后 StDiff 19.1%）。PEP 与全因死亡率降低相关（汇总风险比 0.70，95%置信区间 0.49-0.99；P=0.042）。在调整高血压后，这种关联仍然显著（调整后的汇总风险比 0.68，95%置信区间 0.48-0.97；P=0.036）。