护士主导的晕厥诊所及植入式循环记录仪植入的安全性与结局
Safety and outcome of nurse-led syncope clinics and implantable loop recorder implants.
作者信息
Eftekhari Helen, He Hejie, Lee James Doug, Paul Geeta, Zhupaj Albiona, Lachlan Thomas, Kuehl Michael, Dhanjal Tarv, Panikker Sandeep, Yusuf Shamil, Hayat Sajad, Osman Faizel
机构信息
Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom.
Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom.
出版信息
Heart Rhythm. 2022 Mar;19(3):443-447. doi: 10.1016/j.hrthm.2021.11.006. Epub 2021 Nov 9.
BACKGROUND
Implantable loop recorders (ILRs) are effective in achieving symptom-rhythm correlation. Data on the diagnostic yield of ILRs, on nurse-led syncope clinics, and on nurse-led ILR implants are limited.
OBJECTIVE
We evaluated the safety and efficacy of our nurse-led syncope clinic and nurse-led ILR implants.
METHODS
A retrospective study of all consecutive patients undergoing nurse-led ILR implantations was performed between April 2016 and April 2018. Patients were referred from both nurse-led and physician-led clinics. Data were collected on baseline demographic characteristics, referral source, symptom-rhythm correlation, ILR findings, and subsequent changes to management. All ILRs were enrolled into remote monitoring with automatic arrhythmia detection, and all immediate (≤24 hours) ILR implant complications were recorded. Comparisons were made between nurse-led and physician-led clinics and subsequent outcomes.
RESULTS
A total of 432 patients with an ILR were identified: 164 (38%) from nurse-led and 268 (62%) from physician-led clinics; 200 (46%) were women (mean age 66.5 ± 18.2 years; mean follow-up duration 28.9 ± 9.5 months). Primary ILR indications were syncope (n = 251 [58%]), presyncope (n = 33 [7%]), palpitation (n = 39 [9%]), cryptogenic stroke (n = 78 [18%]), and other reasons (n = 31 [7%]). No immediate ILR implant complications occurred. Overall, 156 patients (36%) had a change in management as a direct result of ILR findings, with no overall differences between nurse-led and physician-led clinics (35% vs 36%; P = .7). More patients had newly diagnosed atrial fibrillation in physician-led clinics (15% vs 7%; P = .01), and more patients had pacemaker implants for bradycardia in nurse-led clinics (23% vs 13%; P < .01).
CONCLUSION
Nurse-led ILR implantation was safe and effective. Nurse-led syncope clinics achieved good symptom-rhythm correlation with resultant significant changes to management in comparison to physician-led clinics. Larger prospective studies are needed to evaluate their longer-term impact.
背景
植入式环路记录器（ILR）在实现症状与节律相关性方面很有效。关于ILR的诊断率、护士主导的晕厥诊所及护士主导的ILR植入的数据有限。
目的
我们评估了护士主导的晕厥诊所及护士主导的ILR植入的安全性和有效性。
方法
对2016年4月至2018年4月期间所有接受护士主导的ILR植入的连续患者进行了一项回顾性研究。患者来自护士主导和医生主导的诊所。收集了关于基线人口统计学特征、转诊来源、症状与节律相关性、ILR检查结果及后续管理变化的数据。所有ILR均纳入具有自动心律失常检测功能的远程监测，并记录所有即刻（≤24小时）ILR植入并发症。对护士主导和医生主导的诊所及后续结果进行了比较。
结果
共确定了432例植入ILR的患者：164例（38%）来自护士主导的诊所，268例（62%）来自医生主导的诊所；200例（46%）为女性（平均年龄66.5±18.2岁；平均随访时间28.9±9.5个月）。ILR的主要适应证为晕厥（n = 251 [58%]）、先兆晕厥（n = 33 [7%]）、心悸（n = 39 [9%]）、不明原因卒中（n = 78 [18%]）及其他原因（n = 31 [7%]）。未发生即刻ILR植入并发症。总体而言，156例患者（36%）因ILR检查结果导致管理发生改变，护士主导和医生主导的诊所之间无总体差异（35%对36%；P = 0.7）。在医生主导的诊所中，新诊断为房颤的患者更多（15%对7%；P = 0.01），在护士主导的诊所中，因心动过缓植入起搏器的患者更多（23%对13%；P < 0.01）。
结论
护士主导的ILR植入是安全有效的。与医生主导的诊所相比，护士主导的晕厥诊所实现了良好的症状与节律相关性，从而使管理发生了显著变化。需要进行更大规模的前瞻性研究来评估其长期影响。
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