Department of Cardiovascular Sciences, University of Leicester, and NIHR Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, Leicestershire LE5 4PW, UK.
National Heart Centre Singapore, Singapore.
Eur J Cardiovasc Nurs. 2022 Nov 23;21(8):830-839. doi: 10.1093/eurjcn/zvac019.
In patients with heart failure (HF), hospitalization rates are increasing, particularly for non-HF causes and over half may be avoidable. Self-monitoring of symptoms plays a key part in the early identification of deterioration. Our objective was to develop expert consensus for a core outcome set (COS) of symptoms to be monitored by patients, using validated single-item patient-reported outcome measures (PROMs), focused on the key priority of reducing admissions in HF.
A rigorous COS development process incorporating systematic review, modified e-Delphi and nominal group technique (NGT) methods. Participants included 24 HF patients, 4 carers, 29 HF nurses, and 9 doctors. In three Delphi and NGT rounds, participants rated potential outcomes on their importance before a HF or a non-HF admission using a 5-point Likert scale. Opinion change between rounds was assessed and a two-thirds threshold was used for outcome selection.Item generation using systematic review identified 100 validated single-item PROMs covering 34 symptoms or signs, relevant to admission for people with HF. De-duplication and formal consensus processes, resulted in a COS comprising eight symptoms and signs; shortness of breath, arm or leg swelling, abdomen bloating, palpitations, weight gain, chest pain, anxiety, and overall health. In the NGT, a numerical rating scale was selected as the optimal approach to symptom monitoring.
Recognition of a range of HF-specific and general symptoms, alongside comorbidities, is an important consideration for admission prevention. Further work is needed to validate and integrate the COS in routine care with the aim of facilitating faster identification of clinical deterioration.
在心力衰竭（HF）患者中，住院率正在上升，尤其是非 HF 原因导致的住院率上升，且超过一半的住院可能是可以避免的。症状自我监测在早期识别病情恶化方面起着关键作用。我们的目标是使用经过验证的单一项目患者报告结局测量（PROM），为患者监测的症状制定核心结局测量集（COS）的专家共识，重点是降低 HF 患者入院率这一关键优先事项。
采用系统评价、改良电子德尔菲法和名义小组技术（NGT）相结合的严格 COS 开发流程。参与者包括 24 名 HF 患者、4 名护理人员、29 名 HF 护士和 9 名医生。在三轮德尔菲法和 NGT 中，参与者使用 5 分李克特量表对 HF 或非 HF 入院前潜在结局的重要性进行评分。评估两轮之间的意见变化，并使用三分之二的阈值来选择结局。使用系统评价生成的项目识别出 100 种经验证的单一项目 PROM，涵盖 34 种与 HF 患者入院相关的症状或体征。经过去重和正式共识过程，确定了包括呼吸困难、手臂或腿部肿胀、腹部肿胀、心悸、体重增加、胸痛、焦虑和整体健康状况在内的八个症状和体征的 COS。在 NGT 中，选择数字评分量表作为监测症状的最佳方法。
认识到一系列 HF 特异性和一般性症状以及合并症，是预防入院的重要考虑因素。需要进一步工作来验证和将 COS 纳入常规护理中，以促进更快地识别临床恶化。
