Mode of Action and Effects of Standardized Collaborative Disease Management on Mortality and Morbidity in Patients With Systolic Heart Failure The Interdisciplinary Network for Heart Failure (INH) Study
Mode of Action and Effects of Standardized Collaborative Disease Management on Mortality and Morbidity in Patients With Systolic Heart Failure The Interdisciplinary Network for Heart Failure (INH) Study
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DOI：
10.1161/circheartfailure.111.962969
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发表时间：
2012-01-01
影响因子：
9.7
通讯作者：
Ertl, Georg
中科院分区：
文献类型：
--
作者：
Angermann, Christiane E.;Stoerk, Stefan;Ertl, Georg
研究心力衰竭疾病管理项目（CDC）疗效的试验报告了相互矛盾的结果。使具体干预措施取得成功的特征往往定义不清。我们评估了护士协调的心脏护理（HeartNetCare-HF，HNC）的作用和效果。方法和结果：因收缩性心力衰竭住院的患者被随机分配到HNC或常规护理（UC）。除了通过电话进行监测和教育外，全国保健委员会还处理病人提出的个人问题，建立保健提供者网络，并为护理人员提供培训。终点为至死亡或再住院（合并原发性）、心力衰竭症状和生活质量（SF-36）的时间。在1007例连续患者中，随机分配了715例（HNC：n = 352; UC：n = 363;年龄：69 ± 12岁; 29%为女性; 40%为纽约心脏协会III-IV级）。在180天内，130名HNC和137名UC患者达到了主要终点（风险比，1.02; 95%置信区间，0.81-1.30; P = 0.89），因为更多的HNC患者再次入院。总体而言，32例HNC和52例UC患者死亡（1例UC患者和4例HNC患者在脱落后死亡）;因此，未删失风险比为0. 62（0. 40 - 0. 96; P = 0. 03）。HNC患者在纽约心脏协会分级（P = 0.05）、身体功能（P = 0.03）和身体健康组成部分（P = 0.03）方面改善更多。除HNC外，两组之间的卫生保健利用率相当。然而，HNC患者要求咨询的非心脏问题，甚至比心血管或心力衰竭相关的issues. Conclusions，这项研究的主要终点是中性的。然而，死亡风险和幸福感的替代指标显著改善。定量评估患者的需求表明，除了（远程）监测个性化护理考虑也非心脏问题，应整合在努力实现更可持续的改善心力衰竭的结果。
Background-Trials investigating efficacy of disease management programs (DMP) in heart failure reported contradictory results. Features rendering specific interventions successful are often ill defined. We evaluated the mode of action and effects of a nurse-coordinated DMP (HeartNetCare-HF, HNC).Methods and Results-Patients hospitalized for systolic heart failure were randomly assigned to HNC or usual care (UC). Besides telephone-based monitoring and education, HNC addressed individual problems raised by patients, pursued networking of health care providers and provided training for caregivers. End points were time to death or rehospitalization (combined primary), heart failure symptoms, and quality of life (SF-36). Of 1007 consecutive patients, 715 were randomly assigned (HNC: n = 352; UC: n = 363; age, 69 +/- 12 years; 29% female; 40% New York Heart Association class III-IV). Within 180 days, 130 HNC and 137 UC patients reached the primary end point (hazard ratio, 1.02; 95% confidence interval, 0.81-1.30; P = 0.89), since more HNC patients were readmitted. Overall, 32 HNC and 52 UC patients died (1 UC patient and 4 HNC patients after dropout); thus, uncensored hazard ratio was 0.62 (0.40-0.96; P = 0.03). HNC patients improved more regarding New York Heart Association class (P = 0.05), physical functioning (P = 0.03), and physical health component (P = 0.03). Except for HNC, health care utilization was comparable between groups. However, HNC patients requested counseling for noncardiac problems even more frequently than for cardiovascular or heart-failure-related issues.Conclusions-The primary end point of this study was neutral. However, mortality risk and surrogates of well-being improved significantly. Quantitative assessment of patient requirements suggested that besides (tele) monitoring individualized care considering also noncardiac problems should be integrated in efforts to achieve more sustainable improvement in heart failure outcomes.