Multidisciplinary group clinic appointments: the Self-Management and Care of Heart Failure (SMAC-HF) trial.
Multidisciplinary group clinic appointments: the Self-Management and Care of Heart Failure (SMAC-HF) trial.
复制标题
多学科团体诊所预约：心力衰竭自我管理和护理 (SMAC-HF) 试验。
DOI：
10.1161/circheartfailure.113.001246
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Ellerbeck,EdwardF
中科院分区：
文献类型：
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作者：
Smith,CarolE;Piamjariyakul,Ubolrat;Wick,JoA;Spertus,JohnA;Russell,Christy;Dalton,KathleenM;Elyachar,Andrea;Vacek,JamesL;Reeder,KatherineM;Nazir,Niaman;Ellerbeck,EdwardF
BackgroundThis trial tested the effects of multidisciplinary group clinic appointments on time to first heart failure（HF）rehospitalization or death.Methods and ResultsHF patients（n=198）were randomly assigned to standard care or standard care plus multidisciplinary group clinics.小组干预包括4次每周门诊预约和1次第6个月的加强门诊，多学科专业人员让患者掌握HF自我管理技能。在完成前4次组门诊预约后（随机化后2个月）开始前瞻性收集12个月的数据。干预与更大的坚持推荐的血管扩张剂（P=0.04）。干预组和标准治疗组分别有22例（24%）和30例（28%）患者发生主要结局（首次HF相关住院或死亡）。总的HF相关住院，包括第一次后的重复住院，干预组为28例，接受标准治疗的为45例。治疗对再住院的影响随时间变化显著。从随机分组后2至7个月，干预组的无住院时间显著更长（考克斯比例风险比=0.45（95%置信区间，0.21-0.98;P=0.04）。两组之间没有显着差异，发现从第8个月至12（危害比=1.7，95%置信区间，0.7-4.1）。ConclusionsMultidisciplinary组门诊预约与更大的坚持选定的HF药物治疗和更长的无住院生存期的时间，干预正在进行中。需要更大规模的研究来证实本试验中观察到的获益，并确定维持这些获益的方法。http://www.clinicaltrials.gov
BackgroundThis trial tested the effects of multidisciplinary group clinic appointments on the primary outcome of time to first heart failure (HF) rehospitalization or death.Methods and ResultsHF patients (n=198) were randomly assigned to standard care or standard care plus multidisciplinary group clinics. The group intervention consisted of 4 weekly clinic appointments and 1 booster clinic at month 6, where multidisciplinary professionals engaged patients in HF self-management skills. Data were collected prospectively for 12 months beginning after completion of the first 4 group clinic appointments (2 months post randomization). The intervention was associated with greater adherence to recommended vasodilators (P=0.04). The primary outcome (first HF-related hospitalization or death) was experienced by 22 (24%) in the intervention group and 30 (28%) in standard care. The total HF-related hospitalizations, including repeat hospitalizations after the first time, were 28 in the intervention group and 45 among those receiving standard care. The effects of treatment on rehospitalization varied significantly over time. From 2 to 7 months post randomization, there was a significantly longer hospitalization-free time in the intervention group (Cox proportional hazard ratio=0.45 (95% confidence interval, 0.21–0.98;P=0.04). No significant difference between groups was found from month 8 to 12 (hazard ratio=1.7; 95% confidence interval, 0.7–4.1).ConclusionsMultidisciplinary group clinic appointments were associated with greater adherence to selected HF medications and longer hospitalization-free survival during the time that the intervention was underway. Larger studies will be needed to confirm the benefits seen in this trial and identify methods to sustain these benefits.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00439842.