Li Yi, Zhao Wenjing, Huang Jun, Zheng Murui, Hu Peng, Lu Jiahai, Deng Hai, Liu Xudong
Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.
Front Cardiovasc Med. 2022 May 17;9:904090. doi: 10.3389/fcvm.2022.904090. eCollection 2022.
The integrated management was evidenced to improve the hospitalization and its associated complications in patients with atrial fibrillation (AF), but the strategies of integrated care varied and results were inconsistent. This systematic review and meta-analysis aimed to evaluate the effect of integrated care on AF-related outcomes with comparison with usual care.
PubMed, Embase, and Web of Science were searched for articles published until 10th January 2022. Eligible studies were randomized controlled trials to study the effect of integrated care on AF-related outcomes. Meta-analysis with a random-effect model was used to calculate risk ratio (RR) and 95% confidence interval (CI) by comparing the integrated care with usual care.
A total of five studies with 6,486 AF patients were selected. By synthesizing available data, integrated care effectively reduced the risk of all-cause mortality (RR = 0.54, 95% CI = 0.42-0.69), cardiovascular hospitalization (RR = 0.72, 95% CI = 0.55-0.94), and cardiovascular mortality (RR = 0.52, 95% CI = 0.36-0.78) when compared with usual care; however, there was no superior effect on preventing AF-related hospitalization (RR = 0.86, 95% CI = 0.72-1.02), cerebrovascular events (RR = 1.13, 95% CI = 0.75-1.70), and major bleeding (RR = 1.29, 95% CI = 0.86-1.94) when comparing integrated care with usual care.
Integrated care can reduce the risk of all-cause mortality, cardiovascular mortality, and cardiovascular hospitalizations in AF patients compared with usual care, while the benefit was not observed in other outcomes.
有证据表明，综合管理可改善心房颤动（AF）患者的住院情况及其相关并发症，但综合护理策略各不相同，结果也不一致。本系统评价和荟萃分析旨在评估综合护理与常规护理相比对AF相关结局的影响。
检索了PubMed、Embase和Web of Science数据库中截至2022年1月10日发表的文章。符合条件的研究为随机对照试验，旨在研究综合护理对AF相关结局的影响。采用随机效应模型进行荟萃分析，通过比较综合护理与常规护理来计算风险比（RR）和95%置信区间（CI）。
共纳入五项研究，涉及6486例AF患者。通过综合现有数据，与常规护理相比，综合护理有效降低了全因死亡率（RR = 0.54，95%CI = 0.42 - 0.69）、心血管住院率（RR = 0.72，95%CI = 0.55 - 0.94）和心血管死亡率（RR = 0.52，95%CI = 0.36 - 0.78）；然而，在预防AF相关住院（RR = 0.86，95%CI = 0.72 - 1.02）、脑血管事件（RR = 1.13，95%CI = 0.75 - 1.70）和大出血（RR = 1.29，95%CI = 0.86 - 1.94）方面，综合护理与常规护理相比并无优势。
与常规护理相比，综合护理可降低AF患者的全因死亡率、心血管死亡率和心血管住院风险，而在其他结局方面未观察到益处。
