针对老年体弱患者的房颤诊断与管理——REAFEL研究
Reaching the Frail Elderly for the Diagnosis and Management of Atrial Fibrillation-REAFEL.
作者信息
Bamberg Carsten, Ladegaard Caroline Thorup, Aalling Mathias, Jensen Dorthea Marie, Madsen Christoffer Læssøe, Kamil Sadaf, Gudbergsen Henrik, Saxild Thomas, Schiøtz Michaela Louise, Grew Julie, Castillo Luana Sandoval, Tousgaard Iben, Johansen Rie Laurine Rosenthal, Bardram Jakob Eyvind, Frølich Anne, Domínguez Helena
机构信息
Cardiology Department Y Bispebjerg and Frederiksberg Hospital, Capital Region, 2000 Frederiksberg, Denmark.
Department of Biomedicine, University of Copenhagen, 1165 Copenhagen, Denmark.
出版信息
Int J Environ Res Public Health. 2023 Sep 19;20(18):6783. doi: 10.3390/ijerph20186783.
BACKGROUND
Frail elderly patients are exposed to suffering strokes if they do not receive timely anticoagulation to prevent stroke associated to atrial fibrillation (AF). Evaluation in the cardiological ambulatory can be cumbersome as it often requires repeated visits.
AIM
To develop and implement CardioShare, a shared-care model where primary care leads patient management, using a compact Holter monitor device with asynchronous remote support from cardiologists.
METHODS
CardioShare was developed in a feasibility phase, tested in a pragmatic cluster randomization trial (primary care clinics as clusters), and its implementation potential was evaluated with an escalation test. Mixed methods were used to evaluate the impact of this complex intervention, comprising quantitative observations, semi-structured interviews, and workshops.
RESULTS
Between February 2020 and December 2021, 314 patients (30% frail) were included, of whom 75% had AF diagnosed/not found within 13 days; 80% in both groups avoided referral to cardiologists. Patients felt safe and primary care clinicians satisfied. In an escalation test, 58 primary-care doctors evaluated 93 patients over three months, with remote support from four hospitals in the Capital Region of Denmark.
CONCLUSIONS
CardioShare was successfully implemented for AF evaluation in primary care.
背景
体弱的老年患者如果不及时接受抗凝治疗以预防与心房颤动（AF）相关的中风，就容易中风。在心脏病门诊进行评估可能很麻烦，因为通常需要多次就诊。
目的
开发并实施CardioShare，这是一种共享护理模式，由初级保健主导患者管理，使用紧凑型动态心电图监测设备，并获得心脏病专家的异步远程支持。
方法
CardioShare在可行性阶段开发，在一项实用的整群随机试验（以初级保健诊所为群组）中进行测试，并通过升级测试评估其实施潜力。采用混合方法评估这一复杂干预措施（包括定量观察、半结构化访谈和研讨会）的影响。
结果
在2020年2月至2021年12月期间，纳入了314名患者（30%为体弱患者），其中75%在13天内确诊/未发现房颤；两组中80%避免了转诊至心脏病专家。患者感到安全，初级保健临床医生也感到满意。在升级测试中，58名初级保健医生在丹麦首都地区四家医院的远程支持下，在三个月内对93名患者进行了评估。
结论
CardioShare已成功应用于初级保健中的房颤评估。
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