心力衰竭入院后在护士主导的心力衰竭诊所对ELAN-HF评分和自我护理行为的验证。
Validation of the ELAN-HF Score and self-care behaviour on the nurse-led heart failure clinic after admission for heart failure.
作者信息
Vinck T A M, Deneer R, Verstappen Ccag, Kok W E, Salah K, Scharnhorst V, Otterspoor L C
机构信息
Department of Cardiology Catharina Hospital, Eindhoven, the Netherlands.
Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands.
出版信息
BMC Nurs. 2022 Jun 21;21(1):158. doi: 10.1186/s12912-022-00914-1.
AIM
To validate the predictive value of the European coLlaboration on Acute decompeNsated Heart Failure (ELAN-HF) score, and to assess the effect of self-care behaviour on readmission and mortality in patients after admission with acute decompensated heart failure (ADHF).
DESIGN
Quantitative, prospective, single centre, cohort study.
METHODS
N-Terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured on admission and discharge, and were used together with clinical and laboratory parameters to calculate the ELAN-HF score. Patients were stratified into four risk groups (low, intermediate, high, very high) according to their ELAN-HF score. The performance of the ELAN-HF score was evaluated and compared to the original study. Self-care behaviour was assessed by the European Heart Failure Self-care Behaviour Scale (EHFScBS-9). Survival analysis was used to estimate the association between both scores and re-admission for HF and/or all-cause mortality within 180 days.
RESULTS
88 patients were included. The median age of the study population was 75 years (IQR 69-83), 43% was female. NYHA III/IV functional class was present at discharge in 68 patients (85%) and 27 patients (34%) had a left ventricular ejection fraction < 40%. Complete data and 180 day follow up was available for 80 patients. 55% reached the endpoint of readmission and/or all-cause mortality. There was a significant association between the ELAN-HF score and re-admission and/or mortality < 180 days (HR = 1.25, 95% CI 1.08-1.45, p = 0.003). The median EHFScBS-9 score was 68.1 (IQR 58.3 - 77.8). There was no significant association between the EHFScBS-9 score and readmission and/or mortality < 180 days (HR = 1.01, 95% CI 0.99-1.03, p = 0.174).
CONCLUSION
This study confirms the validity and therefore the potential of the ELAN-HF score to triage patients with ADHF before discharge. Using this score may optimize the follow-up treatment on the nurse-led heart failure clinic in order to decrease readmission and mortality. Self-care behaviour was non-significantly associated with readmission and/or mortality in our study population.
TRIAL REGISTRATION
This study has been registered with the ethics committee MEC-U (Nieuwegein, The Netherlands), registration nr: V.160999/W18.208/HG/mk.
目的
验证欧洲急性失代偿性心力衰竭协作组（ELAN-HF）评分的预测价值，并评估自我护理行为对急性失代偿性心力衰竭（ADHF）患者入院后再入院率和死亡率的影响。
设计
定量、前瞻性、单中心队列研究。
方法
在入院和出院时测量N末端B型利钠肽原（NT-proBNP）水平，并将其与临床和实验室参数一起用于计算ELAN-HF评分。根据ELAN-HF评分将患者分为四个风险组（低、中、高、极高）。评估ELAN-HF评分的性能并与原始研究进行比较。通过欧洲心力衰竭自我护理行为量表（EHFScBS-9）评估自我护理行为。生存分析用于估计这两个评分与180天内HF再入院和/或全因死亡率之间的关联。
结果
纳入88例患者。研究人群的中位年龄为75岁（四分位间距69-83），43%为女性。出院时68例患者（85%）为纽约心脏协会（NYHA）III/IV级功能分级，27例患者（34%）左心室射血分数<40%。80例患者有完整数据并进行了180天随访。55%达到再入院和/或全因死亡率终点。ELAN-HF评分与180天内再入院和/或死亡率之间存在显著关联（风险比[HR]=1.25，95%置信区间[CI]1.08-1.45，p=0.003）。EHFScBS-9评分的中位数为68.1（四分位间距58.3-77.8）。EHFScBS-9评分与180天内再入院和/或死亡率之间无显著关联（HR=1.01，95%CI0.99-1.03，p=0.174）。
结论
本研究证实了ELAN-HF评分的有效性及其在ADHF患者出院前进行分诊的潜力。使用该评分可优化由护士主导的心力衰竭门诊的后续治疗，以降低再入院率和死亡率。在我们的研究人群中，自我护理行为与再入院和/或死亡率之间无显著关联。
试验注册
本研究已在荷兰乌得勒支医学伦理委员会（MEC-U）注册，注册号：V.160999/W18.208/HG/mk。
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