Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, PR China.
Medicine (Baltimore). 2021 Feb 19;100(7):e24599. doi: 10.1097/MD.0000000000024599.
The European Society of Cardiology guidelines recommend the implementation of nurse-led heart failure programs to achieve optimal management of patients with congestive heart failure (CHF). In this analysis, we aimed to systematically show the impact of nurse-led interventions (NLI) on re-admission and mortality in patients with CHF (reduced ejection fraction).
Publications reporting the impact of NLI on readmission and mortality in patients with CHF were carefully searched from electronic databases. Rehospitalization and mortality were the endpoints. For this analysis, the latest version of the RevMan software was used. Risk ratios (RR) with 95% confidence intervals (CI) were used to represent data following analysis.
A total number of 3282 participants with CHF were included in this analysis. A total of 1571 patients were assigned to the nurse-led intervention group whereas 1711 patients were assigned to the usual care group. The patients had a mean age ranging from 50.8 to 80.3 years. Male patients varied from 27.3% to 73.8%. Comorbidities including hypertension (24.6%-80.0%) and diabetes mellitus (16.7%-59.7%) were also reported. Patients had a mean left ventricular ejection fraction varying from 29.0% to 61.0%. Results of this current analysis showed that rehospitalization (RR: 0.81, 95% CI: 0.74-0.88; P = .00001) and mortality (RR: 0.69, 95% CI: 0.56-0.86; P = .0009) were significantly lower among CHF patients who were assigned to the nurse-led intervention. Whether during a shorter (3-6 months) or a longer (1-2 years) follow up time period, rehospitalization for shorter [(RR: 0.73, 95% CI: 0.65-0.82; P = .00001) vs for longer (RR: 0.81, 95% CI: 0.72-0.91; P = .0003) respectively] and mortality for shorter [(RR: 0.55, 95% CI: 0.38-0.80; P = .002) vs longer follow up time period (RR: 0.76, 95% CI: 0.58-0.99; P = .04) respectively] were significantly lower and in favor of the nurse-led interventional compared to the normal care group.
This systematic review and meta-analysis of randomized controlled trials showed that NLI had significant impacts in reducing the risk of rehospitalization and mortality in these patients with CHF (reduced ejection fraction). Hence, we believe that nurse-led clinics and other interventional programs would be beneficial to patients with heart failure and this practice should, in the future be implemented to the health care system.
欧洲心脏病学会指南建议实施护士主导的心力衰竭项目，以实现充血性心力衰竭（CHF）患者的最佳管理。在这项分析中，我们旨在系统地展示护士主导的干预（NLI）对心力衰竭（射血分数降低）患者再入院和死亡率的影响。
从电子数据库中仔细搜索报告 NLI 对 CHF 患者再入院和死亡率影响的出版物。再入院和死亡率是终点。对于这项分析，使用了最新版本的 RevMan 软件。使用风险比（RR）和 95%置信区间（CI）来表示分析后的结果。
这项分析共纳入 3282 名 CHF 患者。共有 1571 名患者被分配到护士主导的干预组，而 1711 名患者被分配到常规护理组。患者的平均年龄在 50.8 至 80.3 岁之间。男性患者的比例从 27.3%到 73.8%不等。还报告了包括高血压（24.6%-80.0%）和糖尿病（16.7%-59.7%）在内的合并症。患者的平均左心室射血分数在 29.0%至 61.0%之间。目前这项分析的结果表明，与接受常规护理的患者相比，接受护士主导干预的 CHF 患者再入院（RR：0.81，95%CI：0.74-0.88；P=0.00001）和死亡率（RR：0.69，95%CI：0.56-0.86；P=0.0009）显著降低。无论是在较短的（3-6 个月）还是较长的（1-2 年）随访期间，较短时间内的再入院率（RR：0.73，95%CI：0.65-0.82；P=0.00001）和较长时间内的再入院率（RR：0.81，95%CI：0.72-0.91；P=0.0003）均显著降低，而较短时间内的死亡率（RR：0.55，95%CI：0.38-0.80；P=0.002）和较长时间内的死亡率（RR：0.76，95%CI：0.58-0.99；P=0.04）均显著降低，与常规护理组相比，护士主导的干预组更具优势。
这项对随机对照试验的系统评价和荟萃分析表明，NLI 可显著降低这些射血分数降低的心力衰竭（CHF）患者的再入院和死亡率风险。因此，我们相信，护士主导的诊所和其他干预项目将有益于心力衰竭患者，未来应将这种做法纳入医疗保健系统。
