Agostinho João R, Gonçalves Inês, Rigueira Joana, Aguiar-Ricardo Inês, Nunes-Ferreira Afonso, Santos Rafael, Guimarães Tatiana, Alves Pedro, Cunha Nelson, Rodrigues Tiago, André ŃZinga, Pedro Mónica, Veiga Fátima, Pinto Fausto J, Brito Dulce
Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal.
Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal.
Rev Port Cardiol (Engl Ed). 2019 Nov;38(11):755-764. doi: 10.1016/j.repc.2019.03.006. Epub 2020 Jan 28.
Heart failure is associated with high rates of readmission and mortality, and there is a need for measures to improve outcomes. This study aims to assess the impact of the implementation of a protocol-based follow-up program for heart failure patients on readmission and mortality rates and quality of life.
A quasi-experimental study was performed, with a prospective registry of 50 consecutive patients discharged after hospitalization for acute heart failure. The study group was followed by a cardiologist at days 7-10 and the first, third, sixth and 12th month after discharge, with predefined procedures. The control group consisted of patients hospitalized for heart failure prior to implementation of the program and followed on a routine basis.
No significant differences were observed between the two groups regarding mean age (67.1±11.2 vs. 65.8±13.4 years, p=0.5), NYHA functional class (p=0.37), or median left ventricular ejection fraction (27% [19.8-35.3] vs. 29% [23.5-40]; p=0.23) at discharge. Mean follow-up after discharge was similar (11±5.3 vs. 10.9±5.5 months, p=0.81). The protocol-based follow-up program was associated with a significant reduction in all-cause readmission (26% vs. 60%, p=0.003), heart failure readmission (16% vs. 36%, p=0.032), and mortality (4% vs. 20%, p=0.044). In the study group there was a significant improvement in all quality of life measures (p<0.001).
A protocol-based follow-up program for patients with heart failure led to a significant reduction in readmission and mortality rates, and was associated with better quality of life.
心力衰竭与高再入院率和死亡率相关，因此需要采取措施改善治疗结果。本研究旨在评估对心力衰竭患者实施基于方案的随访计划对再入院率、死亡率和生活质量的影响。
进行了一项准实验研究，前瞻性登记了50例因急性心力衰竭住院后连续出院的患者。研究组在出院后第7至10天以及出院后的第1、3、6和12个月由心脏病专家进行随访，并遵循预定义的程序。对照组由该计划实施前因心力衰竭住院并接受常规随访的患者组成。
两组在出院时的平均年龄（67.1±11.2岁对65.8±13.4岁，p = 0.5）、纽约心脏协会（NYHA）功能分级（p = 0.37）或左心室射血分数中位数（27% [19.8 - 35.3]对29% [23.5 - 40]；p = 0.23）方面未观察到显著差异。出院后的平均随访时间相似（11±5.3个月对10.9±5.5个月，p = 0.81）。基于方案的随访计划与全因再入院率（26%对60%，p = 0.003）、心力衰竭再入院率（16%对36%，p = 0.032）和死亡率（4%对20%，p = 0.044）的显著降低相关。在研究组中，所有生活质量指标均有显著改善（p < 0.001）。
针对心力衰竭患者的基于方案的随访计划可显著降低再入院率和死亡率，并与更好的生活质量相关。
