Deschodt Mieke, Van Grootven Bastiaan, Jeuris Anthony, Devriendt Els, Dierckx de Casterlé Bernadette, Dubois Christophe, Fagard Katleen, Herregods Marie-Christine, Hornikx Miek, Meuris Bart, Rex Steffen, Tournoy Jos, Milisen Koen, Flamaing Johan
Gerontology and Geriatrics, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven-University of Leuven, Leuven, Belgium.
Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.
BMJ Open. 2018 Oct 21;8(10):e023593. doi: 10.1136/bmjopen-2018-023593.
Although the majority of older patients admitted to a cardiology unit present with at least one geriatric syndrome, guidelines on managing heart disease often do not consider the complex needs of frail older patients. Geriatric co-management has demonstrated potential to improve functional status, and reduce complications and length of stay, but evidence on the effectiveness in cardiology patients is lacking. This study aims to determine if geriatric co-management is superior to usual care in preventing functional decline, complications, mortality, readmission rates, reducing length of stay and improving quality of life in older patients admitted for acute heart disease or for transcatheter aortic valve implantation, and to identify determinants of success for geriatric co-management in this population.
This prospective quasi-experimental before-and-after study will be performed on two cardiology units of the University Hospitals Leuven in Belgium in patients aged ≥75 years. In the precohort (n=227), usual care will be documented. A multitude of implementation strategies will be applied to allow for successful implementation of the model. Patients in the after cohort (n=227) will undergo a comprehensive geriatric assessment within 24 hours of admission to stratify them into one of three groups based on their baseline risk for developing functional decline: low-risk patients receive proactive consultation, high-risk patients will be co-managed by the geriatric nurse to prevent complications and patients with acute geriatric problems will receive an additional medication review and co-management by the geriatrician.
The study protocol was approved by the Medical Ethics Committee UZ Leuven/KU Leuven (S58296). Written voluntary (proxy-)informed consent will be obtained from all participants at the start of the study. Dissemination of results will be through articles in scientific and professional journals both in English and Dutch and by conference presentations.
NCT02890927.
尽管大多数入住心脏病科的老年患者至少患有一种老年综合征，但心脏病管理指南往往未考虑体弱老年患者的复杂需求。老年共同管理已显示出改善功能状态、减少并发症和缩短住院时间的潜力，但缺乏关于其对心脏病患者有效性的证据。本研究旨在确定老年共同管理在预防急性心脏病或经导管主动脉瓣植入术老年患者功能衰退、并发症、死亡率、再入院率、缩短住院时间和改善生活质量方面是否优于常规护理，并确定该人群中老年共同管理成功的决定因素。
这项前瞻性准实验前后对照研究将在比利时鲁汶大学医院的两个心脏病科对年龄≥75岁的患者进行。在前队列（n = 227）中，将记录常规护理情况。将应用多种实施策略以成功实施该模式。后队列（n = 227）中的患者将在入院后24小时内接受全面的老年评估，根据其发生功能衰退的基线风险分为三组之一：低风险患者接受主动咨询，高风险患者将由老年护士共同管理以预防并发症，患有急性老年问题的患者将接受额外的药物审查并由老年科医生共同管理。
该研究方案已获得鲁汶大学医院/鲁汶大学医学伦理委员会（S58296）的批准。将在研究开始时从所有参与者处获得书面自愿（代理）知情同意书。研究结果将通过发表在英文和荷兰文的科学和专业期刊上的文章以及会议报告进行传播。
NCT02890927。
