Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.
Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
Eur J Heart Fail. 2019 Feb;21(2):238-246. doi: 10.1002/ejhf.1354. Epub 2018 Nov 28.
Efficient incorporation of e-health in patients with heart failure (HF) may enhance health care efficiency and patient empowerment. We aimed to assess the effect on self-care of (i) the European Society of Cardiology/Heart Failure Association website 'heartfailurematters.org' on top of usual care, and (ii) an e-health adjusted care pathway leaving out 'in person' routine HF nurse consultations in stable HF patients.
In a three-group parallel-randomized trial in stable HF patients from nine Dutch outpatient clinics, we compared two interventions ( heartfailurematters.org website and an e-health adjusted care pathway) to usual care. The primary outcome was self-care measured with the European Heart Failure Self-care Behaviour Scale. Secondary outcomes were health status, mortality, and hospitalizations. In total, 450 patients were included. The mean age was 66.8 ± 11.0 years, 74.2% were male, and 78.8% classified themselves as New York Heart Association I or II at baseline. After 3 months of follow-up, the mean score on the self-care scale was significantly higher in the groups using the website and the adjusted care pathway compared to usual care (73.5 vs. 70.8, 95% confidence interval 0.6-6.2; and 78.2 vs. 70.8, 95% confidence interval 3.8- 9.4, respectively). The effect attenuated, until no differences after 1 year between the groups. Quality of life showed a similar pattern. Other secondary outcomes did not clearly differ between the groups.
Both the heartfailurematters.org website and an e-health adjusted care pathway improved self-care in HF patients on the short term, but not on the long term. Continuous updating of e-health facilities could be helpful to sustain effects.
ClinicalTrials.gov ID NCT01755988.
在心力衰竭（HF）患者中有效引入电子医疗可能会提高医疗保健效率并增强患者的自主权。我们旨在评估以下两种方法对自我护理的影响：（i）在常规护理的基础上增加欧洲心脏病学会/心力衰竭协会网站“heartfailurematters.org”，以及（ii）在稳定的 HF 患者中采用电子医疗调整的护理路径，不包括常规 HF 护士门诊“面对面”就诊。
在来自荷兰 9 家门诊诊所的稳定 HF 患者的三臂平行随机试验中，我们比较了两种干预措施（heartfailurematters.org 网站和电子医疗调整的护理路径）与常规护理。主要结局是使用欧洲心力衰竭自我护理行为量表测量的自我护理。次要结局是健康状况、死亡率和住院治疗。共纳入 450 例患者。平均年龄为 66.8±11.0 岁，74.2%为男性，78.8%在基线时自我归类为纽约心脏协会 I 或 II 级。在 3 个月的随访后，与常规护理相比，使用网站和调整后的护理路径的两组患者自我护理量表的平均得分显著更高（73.5 对 70.8，95%置信区间 0.6-6.2；78.2 对 70.8，95%置信区间 3.8-9.4）。这种效果减弱，直到 1 年后各组之间没有差异。生活质量也呈现出类似的模式。其他次要结局在各组之间没有明显差异。
heartfailurematters.org 网站和电子医疗调整的护理路径都在短期内改善了 HF 患者的自我护理，但长期效果并不明显。持续更新电子医疗设施可能有助于维持效果。
ClinicalTrials.gov 编号 NCT01755988。
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