Guangdong Provincial Hospital of Chinese Medicine; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
ESC Heart Fail. 2023 Feb;10(1):133-147. doi: 10.1002/ehf2.14170. Epub 2022 Sep 30.
In recent years, we have developed the concept of 'clinical pathway based on integrated traditional Chinese and western medicine for the management of Chronic heart failure (CHF)'. The purpose of this study was to assess the implementation effects of multifaceted optimization management of chronic heart failure.
A total of nine physicians in optimization group from nine research sites received multifaceted intervention (a 1-day training session on how to implement the optimization programme, a written optimization programme for CHF management, supervision from daily quality coordinator, and 1-monthly monitoring and feedback of performance measure) with respect to the management of CHF, comparing to nine physicians in control group who did not receive the aforementioned multifaceted intervention and diagnosed and treated CHF patients with conventional programme (usual care). After that, a total of 256 patients with CHF were enrolled and randomly assigned to receive optimization programme [integration of usual care and traditional Chinese medicine (TCM) treatment] or conventional programme (usual care) for the treatment of CHF. The primary outcome was the change in New York Heart Association (NYHA) functional classification during 24 weeks of treatment.
When compared with usual care, multifaceted optimization management resulted in superior improvements in NYHA functional classification at the 12-week visit (P = 0.023), the 16-week, 20-week, and 24-week visits (P < 0.001). It also demonstrated superior performance in comparison with the conventional programme with respect to readmission rate for major adverse cardiovascular events (MACEs), readmission rate for worsening heart failure, plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) level, left ventricular ejection fraction (LVEF), patient TCM syndrome scores, quality of life, and patients with heart failure with reduced ejection fraction (HFrEF) in optimization group more likely received beta-blockers and ACE inhibitors or ARBs than those in control group (P = 0.038 and P = 0.013, respectively).
It is likely that the multifaceted optimization programme used in this study is feasible would benefit patients with CHF in NYHA functional classification, readmission for worsening heart failure, plasma NT-proBNP level, LVEF, patient TCM syndrome scores, and quality of life. Additionally, it would improve hospital personnel adherence to evidence-based performance measures for HFrEF.
近年来，我们提出了“基于中西医结合的慢性心力衰竭管理临床路径”的概念。本研究旨在评估慢性心力衰竭多方位优化管理的实施效果。
共有 9 名来自 9 个研究点的优化组医生接受了多方位干预（1 天的优化方案实施培训课程、慢性心力衰竭管理的书面优化方案、日常质量协调员的监督以及 1 个月的绩效评估监测和反馈），与未接受上述多方位干预的 9 名对照组医生相比，对照组医生按照常规方案（常规护理）诊断和治疗心力衰竭患者。之后，共纳入 256 例心力衰竭患者，并随机分为优化组（常规护理与中医药治疗相结合）或常规组（常规护理）接受心力衰竭治疗。主要结局为治疗 24 周时纽约心脏协会（NYHA）功能分级的变化。
与常规护理相比，多方位优化管理在 12 周访视时（P=0.023）、16 周、20 周和 24 周访视时（P<0.001）改善 NYHA 功能分级的效果更优。与常规方案相比，优化组的主要心血管不良事件（MACEs）再入院率、心力衰竭恶化再入院率、血浆 N 末端 B 型利钠肽前体（NT-proBNP）水平、左心室射血分数（LVEF）、患者中医证候评分、生活质量以及射血分数降低的心力衰竭（HFrEF）患者的接受β受体阻滞剂和血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（ARB）的比例均更高（P=0.038 和 P=0.013）。
本研究中使用的多方位优化方案可能是可行的，可使心力衰竭患者在 NYHA 功能分级、心力衰竭恶化再入院、血浆 NT-proBNP 水平、LVEF、患者中医证候评分和生活质量方面获益。此外，它还可以提高医院工作人员对射血分数降低的心力衰竭证据基础绩效评估指标的依从性。
