Dolan Justin, Mandras Stacy, Mehta Jinesh P, Navas Viviana, Tarver James, Chakinala Murali, Rahaghi Franck
Department of Pulmonology, Cleveland Clinic Florida, Weston, FL, USA.
Department of Cardiology, Ochsner Medical Center, Jefferson, LA, USA.
Pulm Circ. 2020 Dec 7;10(4):2045894020968471. doi: 10.1177/2045894020968471. eCollection 2020 Oct-Dec.
Pulmonary hypertension currently has minimal guidelines for outpatient disease management. Congestive heart failure studies, however, have shown effectiveness of disease management plans in reducing all-cause mortality and all-cause and congestive heart failure-related hospital readmissions. Heart failure exacerbation is a common reason for readmission in both pulmonary hypertension and congestive heart failure. Our aim was to review individual studies and comprehensive meta-analyses to identify effective congestive heart failure interventions that can be used to develop similar disease management plans for pulmonary hypertension. A comprehensive literature review from 1993 to 2019 included original articles, systematic reviews, and meta-analyses. We reviewed topics of outpatient congestive heart failure interventions to decrease congestive heart failure mortality and readmission and patient management strategies in congestive heart failure. The most studied interventions included case management, multidisciplinary intervention, structured telephone strategy, and tele-monitoring. Case management showed decreased all-cause mortality at 12 months, all-cause readmission at 12 months, and congestive heart failure readmission at 6 and 12 months. Multidisciplinary intervention resulted in decreased all-cause readmission and congestive heart failure readmission. There was some discrepancy on effectiveness of tele-monitoring programs in individual studies; however, meta-analyses suggest tele-monitoring provided reduced all-cause mortality and risk of congestive heart failure hospitalization. Structured telephone strategy had similar results to tele-monitoring including decreased risk of congestive heart failure hospitalization, without effect on mortality. Extrapolating from congestive heart failure data, it seems strategies to improve the health of pulmonary hypertension patients and development of comprehensive care programs should include structured telephone strategy and/or tele-monitoring, case management strategies, and multidisciplinary interventions.
目前,肺动脉高压在门诊疾病管理方面的指导方针极少。然而,充血性心力衰竭的研究表明,疾病管理计划在降低全因死亡率以及全因和充血性心力衰竭相关的住院再入院率方面具有有效性。心力衰竭加重是肺动脉高压和充血性心力衰竭患者再次入院的常见原因。我们的目的是回顾个体研究和综合荟萃分析,以确定有效的充血性心力衰竭干预措施,可用于制定类似的肺动脉高压疾病管理计划。对1993年至2019年的文献进行全面综述,包括原创文章、系统评价和荟萃分析。我们回顾了门诊充血性心力衰竭干预措施的主题,以降低充血性心力衰竭死亡率和再入院率以及充血性心力衰竭患者管理策略。研究最多的干预措施包括病例管理、多学科干预、结构化电话策略和远程监测。病例管理显示12个月时全因死亡率降低、12个月时全因再入院率降低以及6个月和12个月时充血性心力衰竭再入院率降低。多学科干预导致全因再入院率和充血性心力衰竭再入院率降低。个体研究中远程监测项目的有效性存在一些差异;然而,荟萃分析表明远程监测可降低全因死亡率和充血性心力衰竭住院风险。结构化电话策略与远程监测结果相似,包括降低充血性心力衰竭住院风险,但对死亡率无影响。从充血性心力衰竭数据推断,改善肺动脉高压患者健康状况和制定综合护理计划的策略应包括结构化电话策略和/或远程监测以及病例管理策略和多学科干预。