Chambers John B, Parkin Denise, Rimington Helen, Subbiah Sheila, Campbell Brian, Demetrescu Camelia, Hayes Anna, Rajani Ronak
Guy's and St Thomas' Hospital, London, UK.
Open Heart. 2020 Apr 20;7(1):e001262. doi: 10.1136/openhrt-2020-001262. eCollection 2020.
Guidelines recommend specialist valve clinics as best practice for the assessment and conservative management of patients with heart valve disease. However, there is little guidance on how to set up and organise a clinic. The aim of this study is to describe a clinic run by a multidisciplinary team consisting of cardiologists, physiologist/scientists and a nurse.
The clinical and organisational aims of the clinic, inclusion and exclusion criteria, and links with other services are described. The methods of training non-clinical staff are detailed. Data were prospectively entered onto a database and the study consisted of an analysis of the clinical characteristics and outcomes of all patients seen between 1 January 2009 and 31 December 2018.
There were 2126 new patients and 9522 visits in the 10-year period. The mean age was 64.8 and 55% were male. Of the visits, 3587 (38%) were to the cardiologists, 4092 (43%) to the physiologist/scientists and 1843 (19%) to the nurse. The outcomes from the cardiologist clinics were cardiology follow-up in 460 (30%), referral for surgery in 354 (23%), referral to the physiologist/scientist clinic in 412 (27%) or to the nurse clinic in 65 (4.3%) and discharge in 230 (15%). The cardiologist needed to see 6% from the nurse clinic and 10% from the physiologist/scientist clinic, while advice alone was sufficient in 10% and 9%.
A multidisciplinary specialist valve clinic is feasible and sustainable in the long term.
指南推荐心脏瓣膜病患者的评估与保守治疗的最佳实践是设立专科瓣膜门诊。然而，关于如何设立和组织这样一个门诊的指导却很少。本研究的目的是描述一个由心脏病专家、生理学家/科学家和护士组成的多学科团队运营的门诊。
描述了该门诊的临床和组织目标、纳入和排除标准以及与其他服务的联系。详细介绍了非临床工作人员的培训方法。数据前瞻性地录入数据库，该研究包括对2009年1月1日至2018年12月31日期间所有就诊患者的临床特征和结局进行分析。
在这10年期间，有2126名新患者就诊，共9522人次。平均年龄为64.8岁，男性占55%。在这些就诊人次中，3587人次（38%）是看心脏病专家，4092人次（43%）是看生理学家/科学家，1843人次（19%）是看护士。心脏病专家门诊的结局包括460人次（30%）进行心脏病学随访，354人次（23%）转诊进行手术，412人次（27%）转诊至生理学家/科学家门诊或65人次（4.3%）转诊至护士门诊，230人次（15%）出院。心脏病专家需要看护士门诊转诊来的6%的患者和生理学家/科学家门诊转诊来的10%的患者，而仅提供建议在10%和9%的情况下就足够了。
多学科专科瓣膜门诊从长期来看是可行且可持续的。
