Examining Adherence and Dose Effect of an Early Palliative Care Intervention for Advanced Heart Failure Patients.
Examining Adherence and Dose Effect of an Early Palliative Care Intervention for Advanced Heart Failure Patients.
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对晚期心力衰竭患者早期姑息治疗干预的依从性及剂量效应的研究
DOI：
10.1016/j.jpainsymman.2021.01.136
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发表时间：
2021-09
影响因子：
4.7
通讯作者：
Bakitas M
中科院分区：
文献类型：
--
作者：
Wells R;Dionne-Odom JN;Azuero A;Buck H;Ejem D;Burgio KL;Stockdill ML;Tucker R;Pamboukian SV;Tallaj J;Engler S;Keebler K;Tims S;Durant R;Swetz KM;Bakitas M
研究重点指南强调需要检验姑息治疗（PC）干预措施的“剂量”成分，例如干预依从性和完成率，这些成分有助于实现最佳效果。
在32周的时间内，检验PC干预完成与未完成对晚期心力衰竭（HF）患者生活质量（QoL）和医疗保健使用的“剂量”效应。
对纽约心脏协会（NYHA）III/IV级心力衰竭患者的ENABLE CHF - PC干预试验进行二次分析。“完成者”定义为完成一次面对面的门诊姑息治疗咨询（OPCC）以及每周六次由PC护士教练主导的远程医疗课程。“未完成者”定义为未参加OPCC或完成远程医疗课程少于6次。结果变量为生活质量和医疗资源使用（住院天数；急诊就诊次数）。采用混合模型对32周内“完成者”与“未完成者”的剂量效应进行建模。
在208名干预组参与者中，81人（38.9%）被归类为“完成者”，平均年龄为64.6岁；72.8%居住在城市；92.5%为NYHA III级心力衰竭。“完成者”与“未完成者”组在基线时均衡良好；然而，“未完成者”确实报告了更高的焦虑水平（6.0比7.0，p<0.05，d = 0.28）。在16周时，“完成者”与“未完成者”之间发现了具有临床意义的适度生活质量改善差异（组间差异：-9.71（3.18），d = 0.47，p = 0.002），但医疗保健使用方面无差异。
早期PC干预的较高干预完成率与晚期HF患者的生活质量改善相关。未来的工作应侧重于确定干预成分最有效的“剂量”并提高对其的依从性。
ClinicalTrials.gov标识符：NCT02505425
心力衰竭早期PC干预（ENABLE CHF - PC）的较高干预完成率与晚期HF患者的生活质量改善相关。未来的工作应寻求提高对早期PC干预的依从性，并确定其他有效的干预“剂量”成分。
Research priority guidelines highlight the need for examining the “dose” components of palliative care (PC) interventions, such as intervention adherence and completion rates, that contribute to optimal outcomes. Examine the “dose” effect of PC intervention completion vs. non-completion on quality of life (QoL) and healthcare use in patients with advanced heart failure (HF) over 32 weeks. Secondary analysis of the ENABLE CHF-PC intervention trial for patients with New York Heart Association (NYHA) Class III/IV HF. ‘Completers’ defined as completing a single, in-person outpatient palliative care consultation (OPCC) plus six weekly, PC nurse coach-led telehealth sessions. ‘Non-completers’ were defined as either not attending the OPCC or completing < 6 telehealth sessions. Outcome variables were QoL and healthcare resource use (hospital days; emergency department visits). Mixed models were used to model dose effects for ‘completers’ vs ‘non-completers’ over 32 weeks. Of 208 intervention group participants, 81 (38.9%) were classified as ‘completers’ with a mean age of 64.6 years; 72.8% were urban-dwelling; 92.5% had NYHA Class III HF. ‘Completers’ vs. ‘non-completers’ groups were well-balanced at baseline; however ‘non-completers’ did report higher anxiety (6.0 vs 7.0, p<0.05, d=0.28). Moderate, clinically-significant, improved QoL differences were found at 16-weeks in ‘completers’ vs. ‘non-completers’ (between-group difference: −9.71 (3.18), d=0.47, p=0.002) but not healthcare use. Higher intervention completion rates of an early PC intervention was associated with QoL improvements in patients with advanced HF. Future work should focus on identifying the most efficacious “dose” of intervention components and increasing adherence to them. ClinicalTrials.gov Identifier: NCT02505425 Higher intervention completion of a HF early PC intervention (ENABLE CHF-PC) was associated with QoL improvements in patients with advanced HF. Future work should seek to enhance adherence to early PC interventions and identify other efficacious intervention “dose” components.
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