Krzesiński Paweł, Siebert Janusz, Jankowska Ewa Anita, Galas Agata, Piotrowicz Katarzyna, Stańczyk Adam, Siwołowski Paweł, Gutknecht Piotr, Chrom Paweł, Murawski Piotr, Walczak Andrzej, Szalewska Dominika, Banasiak Waldemar, Ponikowski Piotr, Gielerak Grzegorz
Department of Cardiology and Internal Diseases, Military Institute of Medicine, Szaserow Street 128, Warsaw, 04-141, Poland.
University Center for Cardiology, Medical University of Gdansk, Gdansk, Poland.
ESC Heart Fail. 2021 Apr;8(2):1018-1026. doi: 10.1002/ehf2.13207. Epub 2021 Jan 18.
Heart failure (HF) is characterized by frequent decompensation and an unpredictable trajectory. To prevent early hospital readmission, coordinated discharge planning and individual therapeutic approach are recommended.
We aimed to assess the effect of 1 month of ambulatory care, led by nurses and supported by non-invasive haemodynamic assessment, on the functional status, well-being, and haemodynamic status of patients post-acute HF decompensation.
This study had a multicentre, prospective, and observational design and included patients with at least one hospitalization due to acute HF decompensation within 6 months prior to enrolment. The 1 month ambulatory care included three visits led by a nurse when the haemodynamic state of each patient was assessed non-invasively by impedance cardiography, including thoracic fluid content assessment. The pharmacotherapy was modified basing on haemodynamic assessment. Sixty eight of 73 recruited patients (median age = 67 years; median left ventricular ejection fraction = 30%) finished 1 month follow-up. A significant improvement was observed in both the patients' functional status as defined by New York Heart Association class (P = 0.013) and sense of well-being as evaluated by a visual analogue score (P = 0.002). The detailed patients' assessment on subsequent visits resulted in changes of pharmacotherapy in a significant percentage of patients (Visit 2 = 39% and Visit 3 = 44%).
The proposed model of nurse-led ambulatory care for patients after acute HF decompensation, with consequent assessment of the haemodynamic profile, resulted in: (i) improvement in the functional status, (ii) improvement in the well-being, and (iii) high rate of pharmacotherapy modifications.
心力衰竭（HF）的特点是频繁失代偿且病程难以预测。为防止早期再次入院，建议进行协调的出院计划和个体化治疗方法。
我们旨在评估由护士主导并得到无创血流动力学评估支持的1个月门诊护理对急性HF失代偿患者功能状态、幸福感和血流动力学状态的影响。
本研究采用多中心、前瞻性观察设计，纳入了在入组前6个月内至少因急性HF失代偿住院1次的患者。这1个月的门诊护理包括由护士主导的3次访视，期间通过阻抗心动图对每位患者的血流动力学状态进行无创评估，包括胸腔液体含量评估。根据血流动力学评估调整药物治疗。73例招募患者中的68例（中位年龄 = 67岁；中位左心室射血分数 = 30%）完成了1个月的随访。纽约心脏协会分级定义的患者功能状态（P = 0.013）和视觉模拟评分评估的幸福感（P = 0.002）均有显著改善。在后续访视中对患者的详细评估导致相当比例的患者药物治疗发生改变（第2次访视 = 39%，第3次访视 = 44%）。
所提出的针对急性HF失代偿后患者的护士主导门诊护理模式，以及随之进行的血流动力学评估，带来了：（i）功能状态改善，（ii）幸福感改善，以及（iii）药物治疗调整率高。
