Center for Patient-centered Heart and Lung Research, Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium.
KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, South Africa.
Int J Cardiol. 2020 Feb 1;300:66-72. doi: 10.1016/j.ijcard.2019.07.087. Epub 2019 Jul 30.
Thirty-day all-cause readmissions are high after aortic valve replacement (AVR). We aimed to assess the effectiveness of a structured telephone follow-up (TFU) and a 24/7 hotline on reducing 30-day all-cause readmission (30-DACR) after AVR, on reducing symptoms of anxiety and depression and on improving perceived health state.
A prospective randomized controlled trial was conducted. Patients (n = 288) were randomly allocated to either post-discharge usual care or to care that provided TFU and access to a 24/7 hotline after AVR. Ancillary endpoints were time-to-event (readmission), proportion of avoidable versus unavoidable readmissions after AVR, and predictors of 30-DACR after AVR.
30-DACR was 22.3%. The structured TFU and 24/7 hotline intervention failed to reduce 30-DACR rates after AVR (P = 0.274). Symptoms of anxiety were significantly reduced 30 days after surgery (P = 0.031), an effect that did not persist one year after surgery (P = 0.108). Most readmissions occurred before 15 days post-discharge, and 75% of them were deemed to be unavoidable. Pleural drainage before hospital discharge (P = 0.027) and symptoms of anxiety before surgery (P = 0.003) were predictors of 30-DACR after AVR.
The TFU and 24/7 hotline had no effect on reducing 30-DACR after AVR. However, we did measure reduced symptoms of anxiety the first month after AVR. Anxiety reduction appeared to be an important target for intervention, because we found it to be a risk factor for readmission. Future research should focus on the effectiveness of interventions to prevent avoidable unplanned readmissions.
ClinicalTrial.gov, NCT02522663.
主动脉瓣置换（AVR）后 30 天全因再入院率较高。我们旨在评估结构化电话随访（TFU）和 24/7 热线对降低 AVR 后 30 天全因再入院率（30-DACR）、减轻焦虑和抑郁症状以及改善感知健康状况的有效性。
进行了一项前瞻性随机对照试验。患者（n=288）被随机分配到出院后常规护理或 AVR 后提供 TFU 和 24/7 热线的护理。辅助终点是事件时间（再入院）、AVR 后可避免与不可避免再入院的比例以及 AVR 后 30-DACR 的预测因素。
30-DACR 为 22.3%。结构化 TFU 和 24/7 热线干预未能降低 AVR 后 30-DACR 率（P=0.274）。手术后 30 天焦虑症状显著减轻（P=0.031），但这种效果在手术后一年时不再持续（P=0.108）。大多数再入院发生在出院后 15 天内，其中 75%被认为是不可避免的。出院前胸腔引流（P=0.027）和手术前焦虑症状（P=0.003）是 AVR 后 30-DACR 的预测因素。
TFU 和 24/7 热线对降低 AVR 后 30-DACR 没有影响。然而，我们确实在 AVR 后第一个月测量到焦虑症状减轻。焦虑减轻似乎是干预的一个重要目标，因为我们发现它是再入院的一个风险因素。未来的研究应集中于预防可避免的非计划性再入院的干预措施的有效性。
ClinicalTrials.gov，NCT02522663。
