Chan Yih-Kai, Stickland Nerolie, Stewart Simon
Mary MacKillop Institute for Health Research, The Australian Catholic University, Melbourne, VIC 3000, Australia.
Center for Cardiopulmonary Health, Torrens University Australia, Adelaide, SA 5000, Australia.
Eur J Cardiovasc Nurs. 2023 Jan 12;22(1):33-42. doi: 10.1093/eurjcn/zvac036.
We extended follow-up of a heart failure (HF) prevention study to determine if initially positive findings of improved cardiac recovery were translated into less de novo HF and/or all-cause mortality (primary endpoint) in the longer term.
The Nurse-led Intervention for Less Chronic HF (NIL-CHF) study was a single-centre randomized trial of nurse-led prevention involving cardiac inpatients without HF. At 3 years, 454 survivors (aged 66 ± 11 years, 71% men and 68% coronary artery disease) had the following: (i) a normal echocardiogram (128 cases/28.2%), (ii) structural heart disease (196/43.2%), or (iii) left ventricular diastolic dysfunction/left ventricular systolic dysfunction (LVDD/LVSD: 130/28.6%). Outcomes were examined during median 8.3 (interquartile range 7.8-8.8) years according to these hierarchal groups and change in cardiac status from baseline to 3 years. Overall, 109 (24.0%) participants had a de novo HF admission or died while accumulating 551 cardiovascular-related admissions/3643 days of hospital stay. Progressively worse cardiac status correlated with increased hospitalizations (P < 0.001). The mean rate (95% confidence interval) of cardiovascular admissions/days of hospital stay being 0.09 (0.05-0.12) admissions/0.33 (0.13-0.54) days vs. 0.27 (0.20-0.34) admissions/2.20 (1.36-3.04) days per annum for those with a normal echocardiogram vs. LVDD/LVSD at 3 years. With progressively higher event rates, the adjusted hazard ratio for a de novo HF admission and/or death associated with a structural abnormality (24.5% of cases) and LVDD/LVSD (36.2%) at 3 years was 1.57 (0.82-3.01; P = 0.173) and 2.07 (1.05-4.05; P = 0.035) compared with a normal echocardiogram (10.9%). Mortality also mirrored the direction/extent of cardiac status/trajectory.
These data suggest the positive initial effects of NIL-CHF intervention on cardiac recovery contributed to better long-term outcomes among patients at high risk of HF. However, prevention of HF remains challenging.
我们对一项心力衰竭（HF）预防研究进行了随访扩展，以确定最初关于改善心脏恢复的阳性结果在长期内是否转化为新发HF和/或全因死亡率（主要终点）降低。
护士主导的减少慢性HF干预（NIL-CHF）研究是一项单中心随机试验，由护士主导对无HF的心脏住院患者进行预防干预。3年时，454名幸存者（年龄66±11岁，71%为男性，68%患有冠状动脉疾病）有以下情况：（i）超声心动图正常（128例/28.2%），（ii）结构性心脏病（196例/43.2%），或（iii）左心室舒张功能障碍/左心室收缩功能障碍（LVDD/LVSD：130例/28.6%）。根据这些分层组以及从基线到3年时心脏状态的变化，在中位8.3年（四分位间距7.8 - 8.8年）期间对结局进行了检查。总体而言，109名（24.0%）参与者有新发HF住院或死亡，同时累积了551次心血管相关住院/3643天的住院时间。心脏状态逐渐变差与住院次数增加相关（P < 0.001）。3年时超声心动图正常者与LVDD/LVSD者相比，心血管住院/住院天数的平均发生率（95%置信区间）分别为每年0.09（0.05 - 0.12）次住院/0.33（0.13 - 0.54）天和0.27（0.20 - 0.34）次住院/2.20（1.36 - 3.04）天。随着事件发生率逐渐升高，3年时与结构性异常（24.5%的病例）和LVDD/LVSD（36.2%）相关的新发HF住院和/或死亡的调整后风险比与超声心动图正常者（10.9%）相比分别为1.57（0.82 - 3.01；P = 0.173）和2.07（1.05 - 4.05；P = 0.035）。死亡率也反映了心脏状态/病程的方向/程度。
这些数据表明NIL-CHF干预对心脏恢复的积极初始作用有助于改善HF高危患者的长期结局。然而，HF的预防仍然具有挑战性。
