A bundled care approach to patients with idiopathic pulmonary fibrosis improves transplant-free survival.
A bundled care approach to patients with idiopathic pulmonary fibrosis improves transplant-free survival.
复制标题
DOI：
10.1016/j.rmed.2016.04.010
复制
发表时间：
2016-06
影响因子：
4.3
通讯作者：
de Andrade JA
中科院分区：
文献类型：
--
作者：
Kulkarni T;Willoughby J;Acosta Lara Mdel P;Kim YI;Ramachandran R;Alexander CB;Luckhardt T;Thannickal VJ;de Andrade JA
特发性肺纤维化（IPF）是一种慢性肺部疾病，预后不良，治疗选择有限。2011年ATS/ERS/JRS/ALAT共识声明为IPF患者的管理提供了许多建议。本研究的主要目的是确定在IPF患者管理中“捆绑”这些建议是否会影响临床结局。我们对284名诊断为IPF的患者进行了一项单中心、回顾性队列研究。拟议的捆绑治疗（BOC）组成部分为：（1）每年至少两次到专门的间质性肺病诊所进行肺功能检查评价;（2）每年转诊肺康复;（3）每年定时步行试验;（4）每年超声心动图;（5）胃食管反流治疗。BOC的每个组成部分在每年的随访中得分为“1”，并确定整个随访期间（博茨）以及第一年随访期间（BOCY 1）的平均得分总和（范围为0-5）。主要结果指标是无移植存活率。年龄、性别、吸烟状况、BMI、%FVC、%DLCO在博茨和BOCY 1水平之间没有差异。与最高博茨（>4）的患者相比，最低博茨（≤1）与较低的无移植生存率相关，与年龄和%FVC无关（HR 2.274，CI 1.12- 4.64，p=0.024）。与具有最高BOCY 1的患者相比，较低BOCY 1与较高的移植或死亡风险相关，与年龄和%FVC无关（≤1 vs. >4，HR 2.23，p=0.014; > 1至2 vs. >4，HR 1.87，p=0.011; >2至3 vs. >4，HR 1.72，p=0.019）。具有较高BOC评分的IPF患者的无移植存活率提高。需要前瞻性研究来证实这些结果，并确定IPF患者管理的最佳策略。
Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease with poor prognosis and limited therapeutic options. The 2011 ATS/ERS/JRS/ALAT consensus statement provided a number of recommendations for the management of IPF patients. The primary objective of this study was to determine if “bundling” these recommendations in the management of patients with IPF impacts clinical outcomes. We conducted a single center, retrospective cohort study of 284 patients diagnosed with IPF. The proposed bundle of care (BOC) components were: (1) visits to a specialized interstitial lung diseases clinic with evaluation of pulmonary function tests at least twice yearly; (2) referral to pulmonary rehabilitation yearly; (3) timed walk test yearly; (4) echocardiogram yearly; and (5) gastroesophageal reflux therapy. Each component of the BOC was given a score of “1” per year of follow up, and the average sum of the scores (ranging from 0-5) was determined for the entire period of follow-up (BOCS), as well as during the first year of follow-up (BOCY1). The primary outcome measure was transplant-free survival. Age, gender, smoking status, BMI, %FVC, %DLCO did not differ between levels of BOCS and BOCY1. Lowest BOCS (≤1) was associated with a lower transplant-free survival independent of age and %FVC compared to patients with the highest BOCS (>4) (HR 2.274, CI 1.12- 4.64, p=0.024). Lower BOCY1 was associated with a higher risk for transplant or death independent of age and %FVC in comparison to patients with highest BOCY1 (≤1 vs. >4, HR 2.23, p=0.014; > 1 to 2 vs. >4, HR 1.87, p=0.011; >2 to 3 vs. >4, HR 1.72, p=0.019). IPF patients with higher BOC scores had improved transplant-free survival. Prospective studies are needed to confirm these findings and determine the best strategies for the management of patients with IPF.