护士管理的综合心血管疾病预防计划对住院冠心病患者和初级保健高危患者的纵向影响。
Longitudinal effects of a nurse-managed comprehensive cardiovascular disease prevention program for hospitalized coronary heart disease patients and primary care high-risk patients.
机构信息
Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Kraków, Poland.
Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Kraków, Poland
出版信息
Kardiol Pol. 2020 May 25;78(5):429-437. doi: 10.33963/KP.15273. Epub 2020 Apr 1.
BACKGROUND
The EUROACTION study (nurse‑coordinated multidisciplinary, family‑based cardiovascular disease prevention program) documented the efficacy of a nurse‑managed, comprehensive prevention program in reducing risk factors for cardiovascular disease (CVD). No information was available on survival.
AIMS
The aim of the study was to assess the effects of EUROACTION intervention on CVD risk factors and 12‑year survival in the Polish component of the study.
METHODS
Two district hospitals and 2 primary care practices were allocated randomly to intervention (INT) or usual care (UC). The primary endpoints were lifestyle and risk factors changes at 1‑year follow‑up. Differences in survival were analyzed using the multivariable Cox proportional hazards regression models.
RESULTS
The study involved 628 patients with coronary heart disease (CHD) and 711 high‑risk patients. Compared to UC, INT patients achieved healthier lifestyles and a larger reduction of risk factors at 1 year but these differences were not maintained 12 years after the intervention. Less deaths occurred in patients from the INT hospital and from INT primary practice (hazard ratio [HR], 0.58; 95% CI, 0.42-0.82 and HR, 0.53; 95% CI, 0.3-0.95, respectively). Adjustment for the covariates slightly attenuated the estimates and removed significance (HR, 0.74; 95% CI, 0.52-1.04 and HR, 0.66; 95% CI, 0.36-1.24, respectively). For combined CHD and high‑risk patient groups, compared with UC, INT patients had a 36% lower risk of death after adjustment for age, sex, and history of CHD (HR, 0.64; 95% CI, 0.48-0.86).
CONCLUSIONS
The impact of the EUROACTION intervention on lifestyle and CVD risk factors could have contributed to lower mortality in INT coronary and high‑risk patients. These results emphasize the need for sustaining the interventions to help patients maintain a healthy lifestyle.
背景
EUROACTION 研究（护士协调的多学科、以家庭为基础的心血管疾病预防计划）记录了护士管理的综合预防计划在降低心血管疾病（CVD）风险因素方面的功效。没有关于生存的信息。
目的
本研究旨在评估 EUROACTION 干预对波兰研究部分的 CVD 风险因素和 12 年生存率的影响。
方法
将两家地区医院和 2 家初级保健诊所随机分配到干预（INT）或常规护理（UC）组。主要终点是 1 年随访时生活方式和危险因素的变化。使用多变量 Cox 比例风险回归模型分析生存差异。
结果
该研究涉及 628 例冠心病（CHD）患者和 711 例高危患者。与 UC 相比，INT 患者在 1 年内实现了更健康的生活方式和更大的风险因素降低，但这些差异在干预 12 年后并未得到维持。INT 医院和 INT 初级实践的患者死亡人数较少（危险比[HR]，0.58；95%CI，0.42-0.82 和 HR，0.53；95%CI，0.3-0.95）。对协变量进行调整略微减弱了估计值并消除了显著性（HR，0.74；95%CI，0.52-1.04 和 HR，0.66；95%CI，0.36-1.24）。对于 CHD 和高危患者组，与 UC 相比，INT 患者在调整年龄、性别和 CHD 病史后死亡风险降低 36%（HR，0.64；95%CI，0.48-0.86）。
结论
EUROACTION 干预对生活方式和 CVD 风险因素的影响可能有助于降低 INT 冠心病和高危患者的死亡率。这些结果强调需要维持干预措施，以帮助患者保持健康的生活方式。
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