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将一种针对心力衰竭的新型简短自我管理工具与传统的弗林德斯计划进行评估。

Evaluating a New Short Self-Management Tool in Heart Failure Against the Traditional Flinders Program.

作者信息

Iyngkaran Pupalan, Smith David, McLachlan Craig, Battersby Malcolm, de Courten Maximilian, Hanna Fahad

机构信息

Melbourne Clinical School, University of Notre Dame, Melbourne, VIC 3000, Australia.

Centre for Healthy Futures, Torrens University Australia, Surry Hills, NSW 2000, Australia.

出版信息

J Clin Med. 2024 Nov 20;13(22):6994. doi: 10.3390/jcm13226994.

Abstract

Heart failure (HF) is a complex syndrome, with multiple causes. Numerous pathophysiological pathways are activated. Comprehensive and guideline-derived care is complex. A multidisciplinary approach is required. The current guidelines report little evidence for chronic disease self-management (CDSM) programs for reducing readmission and major adverse cardiovascular events (MACE). CDSM programs can be complex and are not user-friendly in clinical settings, particularly for vulnerable patients. The aim of this study was to investigate whether a simplified one-page CDSM tool, the eening eart ailure (), is comparable to a comprehensive Flinders Program of Chronic Disease Management, specifically in triaging self-management capabilities and in predicting readmission and MACE. is a prospective, observational study based on community cardiology. Eligible patients, consecutively recruited, had HF with left ventricular ejection fraction <40% and were placed on sodium-glucose co-transporter-2 inhibitors (SGLT2-i) within 3 months of recruitment. SGLT2-i is the newest of the four HF treatment pillars; self-management skills are assessed at this juncture. CDSM was assessed and scored independently via the long-form (LF) and short-form () tools, and concordance between forms was estimated. The primary endpoint is the 80% concordance across the two CDSM scales for predicting hospital readmission and MACE. Of the 117 patients, aged 66.8 years (±SD 13.5), 88 (75%) were male. The direct comparisons for versus patient scores are as follows: "good self-managers", 13 vs. 30 patients (11.1% vs. 25.6%); "average", 46 vs. 21 patients (39.3% vs. 17.9%), "borderline", 20 vs. 31 patients (17.1% vs. 26.5%), and "poor self-managers" (vulnerable), 38 vs. 35 patients (32.5% vs. 29.9%). These findings underscore the possibility of tools in picking up patients whose scores infer poor self-management capabilities. This concordance of the with the scores for patients who have poor self-management capabilities (38 vs. 35 patients = 0.01), alongside readmission (31/38 vs. 31/35 = 0.01) or readmission risk for poor self-managers versus good self-managers (31/38 vs. 5/13 = 0.01), validates the simplification of the CDSM tools for the vulnerable population with HF. Similarly, when concurrent and predictive validity was tested on 52 patients, the results were 39 (75%) for poor self-managers and 14 (27%) for good self-managers in both groups, who demonstrated significant correlations between and scores. Simplifying self-management scoring with an tool to improve clinical translation is justifiable, particularly for vulnerable populations. Poor self-management capabilities and readmission risk for poor self-managers can be significantly predicted, and trends for good self-managers are observed. However, correlations of to scores across an HF cohort for self-management abilities and MACE are more complex. Translation to patients of all skill levels requires further research.

摘要

心力衰竭(HF)是一种复杂的综合征,病因多样。众多病理生理途径被激活。全面且遵循指南的护理很复杂,需要多学科方法。当前指南显示,关于慢性疾病自我管理(CDSM)项目可减少再入院率和主要不良心血管事件(MACE)的证据很少。CDSM项目可能很复杂,在临床环境中对用户不友好,尤其是对脆弱患者。本研究的目的是调查一种简化的单页CDSM工具——“晚间心力衰竭()”,是否与全面的弗林德斯慢性病管理项目相当,特别是在对自我管理能力进行分类以及预测再入院率和MACE方面。这是一项基于社区心脏病学的前瞻性观察研究。连续招募的符合条件的患者患有左心室射血分数<40%的HF,并在招募后3个月内开始使用钠-葡萄糖协同转运蛋白2抑制剂(SGLT2-i)。SGLT2-i是四种HF治疗支柱中最新的一种;此时评估自我管理技能。通过长格式(LF)和短格式()工具对CDSM进行独立评估和评分,并估计两种格式之间的一致性。主要终点是两个CDSM量表在预测医院再入院率和MACE方面达到80%的一致性。在117名年龄为66.8岁(±标准差13.5)的患者中,88名(75%)为男性。与患者评分的直接比较如下:“良好自我管理者”,13名对30名患者(11.1%对25.6%);“中等”,46名对21名患者(39.3%对17.9%),“临界”,20名对31名患者(17.1%对26.5%),以及“自我管理能力差”(脆弱),38名对35名患者(32.5%对29.9%)。这些发现强调了工具识别分数表明自我管理能力差的患者的可能性。自我管理能力差的患者的与分数的这种一致性(38名对35名患者 = 0.01),以及再入院率(31/38对31/35 = 0.01)或自我管理能力差的患者与良好自我管理者的再入院风险(31/38对5/13 = 0.01),验证了针对HF脆弱人群简化CDSM工具的合理性。同样,当对52名患者进行同时效度和预测效度测试时,两组中自我管理能力差的患者结果为39名(75%),良好自我管理者为14名(27%),他们的与分数之间显示出显著相关性。使用工具简化自我管理评分以改善临床转化是合理的,特别是对于脆弱人群。可以显著预测自我管理能力差的情况以及自我管理能力差的患者的再入院风险,并且观察到良好自我管理者的趋势。然而,HF队列中自我管理能力和MACE的与分数之间的相关性更为复杂。将其转化应用于所有技能水平的患者需要进一步研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b371/11594953/54d4e43f48f6/jcm-13-06994-g001.jpg

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