远程医疗干预对心力衰竭住院治疗的影响：一项随机试验。

Effect of Telemedicine Interventions on Heart Failure Hospitalizations: A Randomized Trial.

作者信息

Ribeiro Edmar G, Brant Luisa C C, Rezende Lilian C, Bernal Regina, Chequer Graziela, Temponi Barbara V, Vilela Daniel B, Buback Julia B, Lopes Renato D, Franco Tulio B, Ribeiro Antonio L P, Malta Deborah C

机构信息

School of Nursing Universidade Federal de Minas Gerais Belo Horizonte Brazil.

Faculty of Medicine and Telehealth Center, Hospital das Clínicas Universidade Federal de Minas Gerais Belo Horizonte Brazil.

出版信息

J Am Heart Assoc. 2025 Mar 18;14(6):e036241. doi: 10.1161/JAHA.124.036241. Epub 2025 Mar 7.

DOI:10.1161/JAHA.124.036241

PMID:40055862

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12132665/

Abstract

BACKGROUND

Telemedicine interventions (TMIs) for heart failure (HF) can reduce hospitalizations and deaths. It is unclear if low literacy and limited access to technology in low- and middle-income countries affect these benefits. We evaluated whether TMIs added to usual care could reduce HF-related rehospitalizations in patients discharged from hospitals in Brazil.

METHODS

A randomized clinical trial was conducted in 6 public hospitals from September 2021 to June 2022. Patients hospitalized because of HF were randomized to usual care or a multicomponent TMIs. The TMI included weekly nurse-led structured telephone support to monitor weight, blood pressure, heart rate, decompensation signs, and treatment adherence, while promoting self-care education, including diuretic dose adjustments. The nurse was linked to a cardiologist for teleconsultations, according to predefined decision trees. An educational program via text messages was also provided. The primary outcome was HF-related rehospitalizations at 180 days, analyzed by intention-to-treat analysis.

RESULTS

Of 127 randomized patients (TMI, n=70; usual care, n=57), mean±SD age was 64±11 years, 48% were women, 71% were Black race, 33% had <4 years of education, 65% were New York Heart Association class III/IV, and 68% had reduced ejection fraction (≤50%). At 180 days, 26% of the TMI group had HF-related rehospitalizations versus 46% in usual care (relative risk [RR]=0.56, <0.02). All-cause death or rehospitalizations occurred in 30% of the TMI group versus 47% in usual care (RR=0.63, =0.04). Results were consistent in "per-protocol" and subgroup analyses. Enrollment was lower than expected because of COVID-19 disruptions.

CONCLUSIONS

TMI reduced HF-related rehospitalizations, demonstrating its potential to improve clinical outcomes in this population.

REGISTRATION

URL: https://www.ensaiosclinicos.gov.br/rg/RBR-10znr9xn; Unique Identifier: UTN U1111-1263-9802.

摘要

背景

心力衰竭（HF）的远程医疗干预（TMI）可减少住院率和死亡率。尚不清楚低收入和中等收入国家的低文化水平以及技术获取受限是否会影响这些益处。我们评估了在常规治疗基础上增加TMI是否能降低巴西医院出院患者的HF相关再住院率。

方法

2021年9月至2022年6月在6家公立医院进行了一项随机临床试验。因HF住院的患者被随机分为接受常规治疗或多组分TMI。TMI包括每周由护士主导的结构化电话支持，以监测体重、血压、心率、失代偿体征和治疗依从性，同时促进自我护理教育，包括利尿剂剂量调整。根据预定义的决策树，护士与心脏病专家进行远程会诊。还提供了通过短信的教育项目。主要结局是180天时的HF相关再住院率，采用意向性分析进行分析。

结果

在127例随机分组的患者中（TMI组，n = 70；常规治疗组，n = 57），平均±标准差年龄为64±11岁，48%为女性，71%为黑人，33%接受教育年限<4年，65%为纽约心脏协会III/IV级，68%射血分数降低（≤50%）。在180天时，TMI组26%的患者发生HF相关再住院，而常规治疗组为46%（相对风险[RR]=0.56，<0.02）。全因死亡或再住院在TMI组中为30%，而常规治疗组为47%（RR = 0.63，=0.04）。“符合方案”分析和亚组分析结果一致。由于新冠疫情干扰，入组人数低于预期。