Ekman I, Andersson B, Ehnfors M, Matejka G, Persson B, Fagerberg B
Department of Nursing, Umeå University, Sweden.
Eur Heart J. 1998 Aug;19(8):1254-60. doi: 10.1053/euhj.1998.1095.
To evaluate the feasibility of a nurse-monitored, outpatient-care program for elderly patients previously hospitalized with chronic heart failure.
Patients with chronic heart failure hospitalized in the medical wards were screened to find those eligible for a randomized study to compare the effect of a nurse-monitored, outpatient-care programme aiming at symptom management, with conventional care. The inclusion criteria were patients classified in New York Heart Association classes III-IV, age 65 years, and eligibility for an outpatient follow-up programme. The total in-hospital population of patients discharged with a heart-failure diagnosis was surveyed. Eighty-nine per cent of all the hospitalized patients (n=1541) were 65 years old. Of these, 69% (n=1058) were treated in the medical wards which were screened. The study criteria were met by 158 patients (15%). No visits to the nurse occurred in 23 cases among the 79 patients randomized to the structured-care group (29%), mainly on account of death or fatigue. The numbers of hospitalizations and hospital days did not differ between the structured-care and the usual-care groups.
Given the selection criteria and the outline of the interventions, the outpatient, nurse-monitored, symptom-management programme was not feasible for the majority of these elderly patients with moderate-to-severe, chronic heart failure, mainly because of the small proportion of eligible patients and the high drop-out rate. Management of these patients would have to be more adjusted to their home situation.
评估一项由护士监测的门诊护理项目对既往因慢性心力衰竭住院的老年患者的可行性。
对在内科病房住院的慢性心力衰竭患者进行筛查，以找出符合随机研究条件的患者，比较旨在症状管理的护士监测门诊护理项目与传统护理的效果。纳入标准为纽约心脏协会心功能分级为Ⅲ - Ⅳ级、年龄≥65岁且符合门诊随访项目条件的患者。对所有因心力衰竭诊断出院的住院患者总数进行了调查。所有住院患者（n = 1541）中89%年龄≥65岁。其中，69%（n = 1058）在内科病房接受治疗并接受了筛查。158名患者（15%）符合研究标准。在随机分配到结构化护理组的79名患者中，有23例（29%）未去看护士，主要原因是死亡或疲劳。结构化护理组和常规护理组之间的住院次数和住院天数没有差异。
鉴于选择标准和干预措施的概述，对于大多数这些中度至重度慢性心力衰竭老年患者来说，门诊护士监测的症状管理项目不可行，主要原因是符合条件的患者比例小且退出率高。对这些患者的管理必须更适应他们的家庭情况。
