由护士主导并得到医学支持的急性冠状动脉综合征门诊随访模式与单纯医学随访一样安全有效（ANZACS-QI 69）。

A nurse-led and medically supported outpatient follow-up model following an acute coronary syndrome is as safe and effective as medical follow-up alone (ANZACS-QI 69).

作者信息

McLachlan Andrew, Kerr Andrew, Lee Mildred

机构信息

Nurse Practitioner | Mātanga Tapuhi: Department of Cardiology, Middlemore Hospital, Auckland, New Zealand.

Department of Cardiology, Middlemore Hospital, Auckland, New Zealand; School of Population Health, The University of Auckland; Department of Medicine, The University of Auckland.

出版信息

N Z Med J. 2022 Oct 7;135(1563):12-28. doi: 10.26635/6965.5787.

DOI:10.26635/6965.5787

PMID:36201727

Abstract

BACKGROUND

At Middlemore Hospital, acute coronary syndrome (ACS) patients are admitted under the care of one of seven cardiologists working on a weekly rotation. Between 2010 and 2018 patients under the care of three of the cardiologists were followed up in a "medical only" post-ACS follow-up clinic model where the cardiologist or registrar saw all patients. Those admitted under the other four cardiologists were seen in a "nurse-led, cardiologist-supported" follow-up model where the majority of patients were seen by a nurse specialist. The study aim was to compare quality of care and outcomes between patients managed under these two follow-up clinic models.

METHOD

The ANZACS-QI registry was used to identify all ACS admissions, 2010 to 2018. The ANZACS-QI records for 5296 patients, discharged alive, were anonymously linked with hospital clinic follow-up and national administrative datasets. Time to follow-up, medication dispensation and titration and one-year clinical outcomes were compared for the two follow-up models.

RESULTS

Characteristics of patients managed under each model were similar. 4395 patients attended follow up, 74% in the nurse-led model. At one year there were no differences between the medical- and nurse-led cohorts in all-cause mortality (4.6% vs 3.9, p=0.29), rehospitalisations for myocardial infarction (MI) (9.2% vs 8.3%, p=0.31), stroke (1.2% vs 1.4% p=0.71), heart failure (5.7% vs 6.9%, p=0.15) or a combined endpoint of all-cause mortality and/or rehospitalisation for MI/stroke/HF (15.2% vs 14.8%, p=0.71). Patients were seen earlier post-discharge in the nurse-led model, (mean 83 vs 101 days). Medication dispensation one year post-discharge was similar for both models of care.

CONCLUSION

The nurse-led model is associated with earlier access to follow-up, was equally as effective at maintaining secondary prevention pharmacotherapy and associated with similar survival and readmission with non-fatal ACS/stroke/heart failure.

摘要

背景

在米德尔莫尔医院，急性冠状动脉综合征（ACS）患者由七名每周轮流值班的心脏病专家之一负责治疗。2010年至2018年期间，在“仅由医生负责”的ACS后随访门诊模式下，对三名心脏病专家所治疗的患者进行了随访，在此模式下，心脏病专家或住院医生诊治所有患者。由其他四名心脏病专家治疗的患者则采用“护士主导、心脏病专家支持”的随访模式，在此模式下，大多数患者由专科护士诊治。本研究的目的是比较这两种随访门诊模式下患者的治疗质量和预后情况。

方法

利用澳大利亚和新西兰急性冠状动脉综合征质量改进（ANZACS-QI）登记系统确定2010年至2018年期间所有ACS住院患者。对5296名存活出院患者的ANZACS-QI记录进行匿名处理，并与医院门诊随访记录和国家行政数据集相链接。比较两种随访模式的随访时间、药物配给和滴定情况以及一年的临床预后。

结果

每种模式下治疗的患者特征相似。4395名患者接受了随访，其中74%采用护士主导模式。一年时，在全因死亡率（4.6%对3.9%，p=0.29）、因心肌梗死（MI）再次住院（9.2%对8.3%，p=0.31）、中风（1.2%对1.4%，p=0.71）、心力衰竭（5.7%对6.9%，p=0.15）或全因死亡率和/或因MI/中风/心力衰竭再次住院的综合终点方面（15.2%对14.8%，p=0.71），医生主导组和护士主导组之间没有差异。在护士主导模式下，患者出院后更早接受随访（平均83天对101天）。两种护理模式出院一年后的药物配给情况相似。