[通过规范化随访和治疗教育对慢性心力衰竭患者进行门诊管理的益处：USICAR试验结果]

[Interest of ambulatory management of patients with chronic heart failure by protocolized follow-up and therapeutic education: results of the USICAR experiment].

作者信息

Jenneve Anne, Coudrier Guy, Talha Samy, Villalba Noel Lorenzo, Séverac François, Zulfiqar Abrar Ahmad, Arnold Patrick, Lang Philippe, Roul Gérald, Andrès Emmanuel

机构信息

Unité de suivi des patients insuffisants cardiaques, Clinique du Diaconat, Mulhouse, France, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.

Service de physiologie et d'explorations fonctionnelles, Hôpitaux Universitaires de Strasbourg, Strasbourg, France, Équipe de recherche EA 3072 « Mitochondrie, stress oxydant et protection musculaire », Faculté de médecine de Strasbourg, Université de Strasbourg, Strasbourg, France.

出版信息

Geriatr Psychol Neuropsychiatr Vieil. 2021 Mar 1;19(1):42-52. doi: 10.1684/pnv.2021.0917.

DOI:10.1684/pnv.2021.0917

PMID:33692016

Abstract

OBJECTIVE

The objective of this study is to determine whether the implementation of regular and structured follow-up of patients with chronic heart failure (CHF), combined with therapeutic education, led to better management of these patients.

PATIENTS AND METHOD

This was a monocentric, retrospective study on a cohort of patients with a proven CHF, followed in the Mulhouse region (France), between January 2016 and December 2017, by the Unit for Monitoring Heart Failure Patients (USICAR). These patients benefited from a regular protocolized follow-up and a therapeutic education program for a period of 2 years. The main criterion of this study was: the number of days of hospitalization for HF per year and per patient. The secondary endpoints were: the number of days of hospitalization for cardiac causes other than HF and the number of hospital stays for HF per patient. These criteria were collected over the one-year period before inclusion, at one-year-follow-up, and at two-years-follow-up.

RESULTS

159 patients with a mean age of 72.9 years were included in this study. They all had a CHF, mainly stage I-II NYHA (88.7%), of predominantly ischemic origin (50.9%), with altered left ventricular ejection fraction in 69.2% of cases. The primary endpoint averaged 8.33 days (6.84-10.13) in the year prior to inclusion, 2.6 days (1.51-4.47) in the first year of follow-up, and 2.82 days (1.30-6.11) (p <0.01 for both comparisons). The mean number of days of hospitalization for other cardiac causes other than HF to patient numbers was: 1.73 days (1.16-2.6), 1.81 days (1.04-3.16), and 1.32 days (0.57-3.08) (p = ns). The percentage of hospitalization for HF for each patient was: 69.5% (60.2-77.4) before inclusion, 16.2% (10-25.2) during the first year of follow-up and 19.3% (11-31.8) during the second (p < 0.001 for both comparisons).

CONCLUSION

This study demonstrates the value of a protocolized follow-up associated with a therapeutic education program to improve the management of ambulatory CHF patients, particularly for moderate CHF.

摘要

目的

本研究的目的是确定对慢性心力衰竭（CHF）患者实施定期且结构化的随访，并结合治疗教育，是否能使这些患者得到更好的管理。

患者与方法

这是一项单中心回顾性研究，研究对象为2016年1月至2017年12月期间在法国米卢斯地区由心力衰竭患者监测单位（USICAR）随访的确诊CHF患者队列。这些患者在2年的时间里受益于定期的标准化随访和治疗教育计划。本研究的主要标准是：每年每位患者因心力衰竭住院的天数。次要终点是：因心力衰竭以外的心脏原因住院的天数以及每位患者因心力衰竭住院的次数。这些标准在纳入前一年、随访一年时和随访两年时收集。

结果

本研究纳入了159例平均年龄为72.9岁的患者。他们均患有CHF，主要为纽约心脏病协会（NYHA）I-II期（88.7%），主要病因是缺血性（50.9%），69.2%的病例左心室射血分数改变。纳入前一年主要终点的平均值为8.33天（6.84 - 10.13），随访第一年为2.6天（1.51 - 4.47），随访第二年为2.82天（1.30 - 6.11）（两次比较p均<0.01）。因心力衰竭以外的其他心脏原因住院天数与患者人数的平均值为：1.73天（1.16 - 2.6）、1.81天（1.04 - 3.16）和1.32天（0.57 - 3.08）（p =无显著差异）。每位患者因心力衰竭住院的百分比为：纳入前69.5%（60.2 - 77.4），随访第一年16.2%（10 - 25.2），随访第二年19.3%（11 - 31.8）（两次比较p均<0.001）。