Zhang Min, Chen Jianjing, Gao Chunmei, Gu Shunzhong, Yang Ping, Xu Zhenlan
Department of Cardiology, Hai'an People's Hospital, Jiangsu Province Hai'an 226600, Jiangsu Province, China.
Libao Central Health Cente, Hai'an City, Jiangsu Province Hai'an 226600, Jiangsu Province, China.
Am J Transl Res. 2022 May 15;14(5):3269-3277. eCollection 2022.
To explore the effect of the whole-process health management model on the compliance of oral warfarin treatment in patients with non-valvular atrial fibrillation in primary hospitals.
We retrospectively analyzed the clinical data of 130 patients with non-valvular atrial fibrillation treated in the Department of Cardiovascular Medicine, Hai'an People's Hospital from January 2019 to December 2019. Among them, 63 patients who received routine continuing care were included in the control group, and 67 patients treated with whole-course health management model of primary hospitals were included in the observation group. The two groups were compared in terms of the following parameters: Warfarin anticoagulation knowledge, medication compliance, compliance rate (international normalized ratio, INR) monitoring, bleeding events (gingival bleeding, subcutaneous bleeding, gastrointestinal bleeding, etc.), embolic events (vascular thrombosis), negative emotions before and after management, and patient satisfaction. Logistic analysis was used to analyze independent risk factors affecting the effect of warfarin anticoagulation in patients with non-valvular atrial fibrillation.
Compared with the control group, the warfarin anticoagulation knowledge, medication compliance, and INR compliance rate of the observation group were significantly higher, and the incidence of adverse events was significantly lower. Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores were not significantly different between the two groups before management. After management, SAS and SDS scores decreased significantly in both groups, and were lower in the observation group compared with the control group. The management satisfaction was also significantly higher in the observation group.
Compared with the conventional continuation care model, the whole-process management in primary hospitals can improve patients' compliance with medical advice and treatment efficacy, with lower risk of bleeding and higher patient satisfaction, providing a better option for the out-of-hospital management of anticoagulation for non-valvular atrial fibrillation patients. Age, hypertension, diabetes, knowledge of warfarin anticoagulation and medication compliance were independent risk factors for the effect of warfarin anticoagulation in patients with non-valvular atrial fibrillation.
探讨全程健康管理模式对基层医院非瓣膜性心房颤动患者口服华法林治疗依从性的影响。
回顾性分析2019年1月至2019年12月在海安市人民医院心血管内科治疗的130例非瓣膜性心房颤动患者的临床资料。其中，63例接受常规延续性护理的患者纳入对照组，67例采用基层医院全程健康管理模式治疗的患者纳入观察组。比较两组以下指标：华法林抗凝知识、用药依从性、达标率（国际标准化比值，INR）监测、出血事件（牙龈出血、皮下出血、胃肠道出血等）、栓塞事件（血管血栓形成）、管理前后的负面情绪以及患者满意度。采用Logistic分析影响非瓣膜性心房颤动患者华法林抗凝效果的独立危险因素。
与对照组相比，观察组的华法林抗凝知识、用药依从性及INR达标率显著更高，不良事件发生率显著更低。两组管理前的焦虑自评量表（SAS）和抑郁自评量表（SDS）评分差异无统计学意义。管理后，两组的SAS和SDS评分均显著降低，且观察组低于对照组。观察组的管理满意度也显著更高。
与传统延续性护理模式相比，基层医院的全程管理可提高患者的医嘱依从性和治疗效果，出血风险更低，患者满意度更高，为非瓣膜性心房颤动患者院外抗凝管理提供了更好的选择。年龄、高血压、糖尿病、华法林抗凝知识及用药依从性是非瓣膜性心房颤动患者华法林抗凝效果的独立危险因素。
