Katano Satoshi, Yano Toshiyuki, Numazawa Ryo, Nagaoka Ryohei, Yamano Kotaro, Fujisawa Yusuke, Honma Suguru, Watanabe Ayako, Ohori Katsuhiko, Kouzu Hidemichi, Fujito Takefumi, Ishigo Tomoyuki, Kunihara Hayato, Fujisaki Hiroya, Katayose Masaki, Hashimoto Akiyoshi, Furuhashi Masato
Division of Rehabilitation, Sapporo Medical University Hospital Sapporo Japan.
Second Division of Physical Therapy, Sapporo Medical University School of Health Science Sapporo Japan.
Circ Rep. 2023 Jun 20;5(7):271-281. doi: 10.1253/circrep.CR-23-0049. eCollection 2023 Jul 10.
A multidisciplinary team (MDT) approach is crucial for managing older patients with heart failure (HF). We investigated the impact on clinical outcomes of implementation of a conference sheet (CS) with an 8-component radar chart for visualizing and sharing patient information. We enrolled 395 older inpatients with HF (median age 79 years [interquartile range 72-85 years]; 47% women) and divided them into 2 groups according to CS implementation: a non-CS group (before CS implementation; n=145) and a CS group (after CS implementation; n=250). The clinical characteristics of patients in the CS group were assessed using 8 scales (physical function, functional status, comorbidities, nutritional status, medication adherence, cognitive function, HF knowledge level, and home care level). In-hospital outcomes (Short Physical Performance Battery, Barthel Index score, length of hospital stay, and hospital transfer rate) were significantly better in the CS than non-CS group. During the follow-up period, 112 patients experienced composite events (all-cause death or admission for HF). Inverse probabilities of treatment-weighted Cox proportional hazard analyses demonstrated a 39% reduction in risk of composite events in the CS group (adjusted hazard ratio 0.65; 95% confidence interval 0.43-0.97). Radar chart-based information sharing among MDT members is associated with superior in-hospital clinical outcomes and a favorable prognosis.
多学科团队(MDT)方法对于管理老年心力衰竭(HF)患者至关重要。我们研究了采用包含8个组成部分的雷达图的会诊单(CS)来可视化和共享患者信息对临床结局的影响。我们纳入了395名老年HF住院患者(中位年龄79岁[四分位间距72 - 85岁];47%为女性),并根据CS实施情况将他们分为两组:非CS组(CS实施前;n = 145)和CS组(CS实施后;n = 250)。使用8个量表(身体功能、功能状态、合并症、营养状况、药物依从性、认知功能、HF知识水平和家庭护理水平)评估CS组患者的临床特征。CS组的院内结局(简短身体表现量表、巴氏指数评分、住院时间和医院转诊率)显著优于非CS组。在随访期间,112名患者发生了复合事件(全因死亡或因HF入院)。治疗加权Cox比例风险分析显示CS组复合事件风险降低了39%(调整后风险比0.65;95%置信区间0.43 - 0.97)。MDT成员之间基于雷达图的信息共享与更好的院内临床结局和良好的预后相关。