Wang Yongxia, Wei Jingjing, Yu Rui, Wang Xinlu, Li Xingyuan, Peng Guangcao, Ren Hongjie, Wang Jianru, Zhao Qifei, Zhang Yanbo, Li Bin, Guo Hongxin, Sun Yang, Qiao Lijie, Lei Jiabao, Zhu Mingjun, Wang Duolao
Heart Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.
Department of Neurological Intensive Care, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.
BMC Cardiovasc Disord. 2024 Dec 20;24(1):732. doi: 10.1186/s12872-024-04431-8.
Cardiovascular and cerebrovascular diseases (CVDs) present a significant challenge in the realm of chronic disease management in China. The objective of this study is to assess the efficacy of a health management model rooted in a three-tier prevention and control system for CVDs.
From August 2020 to September 2020, this study enrolled 2033 CVDs patients from 105 villages across three townships in central China. All participants underwent a 12-month health management involving monitoring, risk assessment, health education, and interventions. The primary endpoint focused on recurrence and exacerbation, while secondary outcomes encompassed health economic indicators, awareness of prevention and control knowledge, risk factor, lifestyle behavior. Data analysis was conducted using generalized estimating equation models.
After 1 year of follow-up, the odds of recurrence and exacerbation decreased significantly compared to the baseline [odds ratio (OR) 0.30, 95% confidence interval (CI): 0.26, 0.35], accompanied by reduced hospitalization frequency [mean difference (MD) -0.61, 95% CI: -0.66, -0.56] and a monthly average reduction in medication costs (MD, -69.80, 95% CI: -104.55, -35.05). Moreover, patients' awareness of CVDs prevention and treatment knowledge markedly improved (P < 0.01). Diastolic blood pressure, blood lipid and plasma glucose levels, anxiety and depression, lifestyle behavior all demonstrated significant enhancements from baseline levels (P < 0.01). Crucially, health management did not result in an increased abnormality rate of safety indicators.
The health management model, grounded in a three-level prevention and control system, showed potential applicability in reducing recurrence and exacerbation, easing healthcare economic burden, boosting awareness of prevention and treatment, and positively influencing risk factors. Additional multicenter and long-term studies are necessary to validate these findings and support broader implementation of this model.
Chinese Clinical Trial Registry (ChiCTR) ChiCTR2000032243 (24/04/2020) ( https://www.chictr.org.cn/showproj.html?proj=52395 ).
在中国，心血管疾病（CVDs）是慢性病管理领域面临的一项重大挑战。本研究的目的是评估基于心血管疾病三级防控体系的健康管理模式的效果。
2020年8月至2020年9月，本研究在中国中部三个乡镇的105个村庄招募了2033名心血管疾病患者。所有参与者均接受了为期12个月的健康管理，包括监测、风险评估、健康教育和干预措施。主要终点为复发和病情加重情况，次要结果包括健康经济指标、防控知识知晓情况、危险因素、生活方式行为。采用广义估计方程模型进行数据分析。
经过1年的随访，与基线相比，复发和病情加重的几率显著降低[比值比（OR）0.30，95%置信区间（CI）：0.26，0.35]，住院频率降低[平均差值（MD）-0.61，95%CI：-0.66，-0.56]，每月药物费用平均减少（MD，-69.80，95%CI：-104.55，-35.05）。此外，患者对心血管疾病防治知识的知晓率显著提高（P < 0.01）。舒张压、血脂和血糖水平、焦虑和抑郁、生活方式行为均较基线水平有显著改善（P < 0.01）。至关重要的是，健康管理并未导致安全指标异常率增加。
基于三级防控体系的健康管理模式在降低复发和病情加重、减轻医疗经济负担、提高防治意识以及对危险因素产生积极影响方面显示出潜在的适用性。需要更多的多中心和长期研究来验证这些发现，并支持该模式的更广泛实施。
中国临床试验注册中心（ChiCTR）ChiCTR2000032243（2020年4月24日）（https://www.chictr.org.cn/showproj.html?proj=52395）
