Valk M J M, Hoes A W, Mosterd A, Landman M A, Zuithoff N P A, Broekhuizen B D L, Rutten F H
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands.
Neth Heart J. 2020 Nov;28(11):604-612. doi: 10.1007/s12471-020-01487-x.
To assess whether a single training session for general practitioners (GPs) improves the evidence-based drug treatment of heart failure (HF) patients, especially of those with HF with reduced ejection fraction (HFrEF).
A cluster randomised controlled trial was performed for which patients with established HF were eligible. Primary care practices (PCPs) were randomised to care-as-usual or to the intervention group in which GPs received a half-day training session on HF management. Changes in HF medication, health status, hospitalisation and survival were compared between the two groups. Fifteen PCPs with 200 HF patients were randomised to the intervention group and 15 PCPs with 198 HF patients to the control group. Mean age was 76.9 (SD 10.8) years; 52.5% were female. On average, the patients had been diagnosed with HF 3.0 (SD 3.0) years previously. In total, 204 had HFrEF and 194 HF with preserved ejection fraction (HFpEF). In participants with HFrEF, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers decreased in 6 months in both groups [5.2%; (95% confidence interval (CI) 2.0-10.0)] and 5.6% (95% CI 2.8-13.4)], respectively [baseline-corrected odds ratio (OR) 1.07 (95% CI 0.55-2.08)], while beta-blocker use increased in both groups by 5.2% (95% CI 2.0-10.0) and 1.1% (95% CI 0.2-6.3), respectively [baseline-corrected OR 0.82 (95% CI 0.42-1.61)]. For health status, hospitalisations or survival after 12-28 months there were no significant differences between the two groups, also not when separately analysed for HFrEF and HFpEF.
A half-day training session for GPs does not improve drug treatment of HF in patients with established HF.
评估为全科医生（GP）提供一次培训课程是否能改善心力衰竭（HF）患者，尤其是射血分数降低的心力衰竭（HFrEF）患者的循证药物治疗。
开展了一项整群随机对照试验，确诊HF的患者符合条件。基层医疗实践机构（PCP）被随机分为常规治疗组或干预组，干预组的全科医生接受了为期半天的HF管理培训。比较两组之间HF药物治疗、健康状况、住院情况和生存率的变化。15个PCP机构的200例HF患者被随机分配至干预组，15个PCP机构的198例HF患者被分配至对照组。平均年龄为76.9（标准差10.8）岁；52.5%为女性。患者平均在3.0（标准差3.0）年前被诊断为HF。共有204例HFrEF患者和194例射血分数保留的心力衰竭（HFpEF）患者。在HFrEF参与者中，两组在6个月内血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的使用分别下降了5.2%[95%置信区间（CI）2.0 - 10.0]和5.6%（95% CI 2.8 - 13.4）[基线校正比值比（OR）1.07（95% CI 0.55 - 2.08）]，而两组β受体阻滞剂的使用分别增加了5.2%（95% CI 2.0 - 10.0）和1.1%（95% CI 0.2 - 6.3）[基线校正OR 0.82（95% CI 0.42 - 1.61）]。对于健康状况、12 - 28个月后的住院情况或生存率，两组之间没有显著差异，对HFrEF和HFpEF分别进行分析时也没有显著差异。
为全科医生提供为期半天的培训课程并不能改善确诊HF患者的HF药物治疗。
