Cardiovascular Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
J Cardiovasc Med (Hagerstown). 2020 Mar;21(3):231-237. doi: 10.2459/JCM.0000000000000934.
The efficacy of a telephone support program in chronic heart failure has been questioned particularly when considering short-term follow-up. This study is aimed to assess the impact of the HeartNetCare telephone support program in chronic heart failure within 18 months of observation and to verify a possible effect of a learning-to-care curve on outcome.
We retrospectively compared a cohort of 269 chronic heart failure patients included in HeartNetCare program with 200 patients receiving usual care as a control group. All-cause death and hospitalization for heart failure or implantation of left ventricular assist device were the primary composite outcome. Secondary endpoints were the changes in left ventricular ejection fraction and in New York Heart Association (NYHA) functional class. Outcome data were also analyzed in relation to the time of enrollment from program initiation.
At baseline, HeartNetCare group showed lower ejection fraction and higher NYHA class. At the follow-up, 59 HeartNetCare patients (21.9%) and 49 usual care patients (24.5%) reached the primary endpoint (P = 0.51). After 18 months of follow-up, HeartNetCare patients improved ejection fraction and NYHA class compared with the usual care patients (P < 0.001). We also observed that the HeartNetCare patients enrolled after 12 months from the initiation of the program had a more favorable outcome in primary endpoint compared with controls.
These results indicate that the long-term impact of a structured telephone support program might be able to positively influence symptoms and reduce events in chronic heart failure. These appreciable effects where more evident after an initial period essential for completing the learning-to-care curve.
电话支持计划在慢性心力衰竭中的疗效一直受到质疑，尤其是在考虑短期随访时。本研究旨在评估 HeartNetCare 电话支持计划在观察期 18 个月内对慢性心力衰竭的影响，并验证学习护理曲线对结果的可能影响。
我们回顾性比较了 HeartNetCare 计划中 269 例慢性心力衰竭患者组成的队列与接受常规护理的 200 例对照组患者。全因死亡和心力衰竭住院或植入左心室辅助装置是主要复合终点。次要终点是左心室射血分数和纽约心脏协会（NYHA）功能分级的变化。还根据从计划开始到入组的时间分析了结局数据。
基线时，HeartNetCare 组的射血分数较低，NYHA 分级较高。在随访中，59 例 HeartNetCare 患者（21.9%）和 49 例常规护理患者（24.5%）达到了主要终点（P=0.51）。在 18 个月的随访后，与常规护理组相比，HeartNetCare 组的射血分数和 NYHA 分级得到改善（P<0.001）。我们还观察到，从计划启动后 12 个月开始入组的 HeartNetCare 患者的主要终点结局比对照组更有利。
这些结果表明，结构化电话支持计划的长期影响可能能够积极影响慢性心力衰竭患者的症状并减少事件。这些明显的效果在完成学习护理曲线的初始阶段后更为明显。
