Department of Cardiology, Hospital Universitario 12 de Octubre, CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
Los Angeles Primary Care Center, Madrid, Spain.
Med Clin (Barc). 2019 Jun 7;152(11):431-437. doi: 10.1016/j.medcli.2018.08.005. Epub 2018 Oct 9.
Several trials have evaluated the effect of disease management programs in heart failure (HF) with diverse results. The aim of this study was to develop a simple nurse-led clinic intervention program for patients with HF and assess whether this intervention positively affects the prognosis of patients, their care costs and perceived quality of life (QoL).
Between 2011 and 2013, 127 patients with reduced ejection fraction were prospectively randomly allocated (1:2) to standard care or intervention program. Primary composite endpoint was all-cause mortality and hospital readmissions. Secondary endpoints were all-cause mortality, all-cause hospital readmissions, readmissions for HF, time to first readmission and QoL improvements assessed by "Minnesota Living with Heart Failure Questionnaire" (MLHFQ). An intention-to-treat analysis was performed.
After a median follow-up of 2-years, no differences were found in the primary composite endpoint. Likewise, there were no differences between groups in the predefined secondary endpoints of mortality and readmissions from any cause. However, in the intervention group, readmissions for HF were significantly reduced (35% vs. 18%; p=0.04) and QoL significantly improved (MLHFQ±SD: 2.29±14 vs. 10.9±14.75; p=0.04).
In patients with HF, the use of a nurse-led intervention program significantly improves perceived QoL and reduce HF hospital readmissions.
多项试验评估了不同心力衰竭（HF）疾病管理方案的效果，结果不一。本研究旨在为 HF 患者制定一个简单的护士主导的门诊干预方案，并评估该方案是否能积极影响患者预后、医疗费用和感知生活质量（QoL）。
2011 年至 2013 年，前瞻性随机分配 127 例射血分数降低的患者至标准治疗或干预组（1:2）。主要复合终点为全因死亡率和住院再入院。次要终点为全因死亡率、全因住院再入院、HF 住院再入院、首次再入院时间和 QoL 改善，采用“明尼苏达心力衰竭生活质量问卷”（MLHFQ）评估。进行意向治疗分析。
中位随访 2 年后，主要复合终点无差异。同样，两组死亡率和任何原因导致的再入院的次要终点也无差异。然而，干预组 HF 住院再入院显著减少（35% vs. 18%；p=0.04），QoL 显著改善（MLHFQ±SD：2.29±14 vs. 10.9±14.75；p=0.04）。
在 HF 患者中，使用护士主导的干预方案可显著改善感知 QoL，并减少 HF 住院再入院。
