Effects of self-management intervention on health outcomes of patients with heart failure: a systematic review of randomized controlled trials.
Effects of self-management intervention on health outcomes of patients with heart failure: a systematic review of randomized controlled trials.
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DOI：
10.1186/1471-2261-6-43
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发表时间：
2006-11-02
影响因子：
2.1
通讯作者：
Straus, Sharon E
中科院分区：
文献类型：
--
作者：
Jovicic, Aleksandra;Holroyd-Leduc, Jayna M;Straus, Sharon E
背景：心力衰竭是65岁以上成年人住院的最常见原因。超过60%的患者在首次出现症状后10年内死亡。本研究的目的是确定自我管理干预措施对心力衰竭患者的再住院率、死亡率和健康相关生活质量的有效性。使用了以下数据来源：Medline(1966-11/2005)、EMBASE(1980-11/2005)、CINAHL(1982-11/2005)、ACP期刊俱乐部数据库(至2005/11)、Cochrane中央试验登记处和Cochrane系统评价数据库(至2005/11)；文章参考清单；以及该领域的专家。我们纳入了自我管理干预的随机对照试验，纳入了18岁或18岁以上被诊断为心力衰竭的患者。令人感兴趣的主要结果是各种原因导致的再入院、因心力衰竭再入院以及死亡率。次要结果是治疗依从性和生活质量评分。三位评价员独立评估了每项研究的质量，并将结果提炼出来。对于每个纳入的研究，我们计算了各种原因再入院、因心力衰竭再入院和死亡的合并优势比(OR)。我们使用一个固定的效应模型来定量地综合结果。我们无法汇集对健康相关生活质量的影响和治疗依从性的衡量标准，但我们总结了相关研究的结果。结果：在确定的671条引文中，有6项随机试验、857名患者纳入综述。自我管理减少了全因再入院(OR0.59；95%可信区间0.44至0.80，P=0.001)和心力衰竭再入院(OR0.44；95%可信区间0.27至0.71，P=0.001)。对死亡率的影响无统计学意义(OR=0.93；95%CI为0.57~1.51，P=0.76)。对处方医疗建议的依从性有所改善，但在功能能力、症状状态和生活质量方面没有显著差异。据报道，每位患者每年节省的费用从1300美元到7515美元不等。结论：针对心力衰竭患者的自我管理计划减少了因心力衰竭而重新入院和再入院的总人数。
BACKGROUND: Heart failure is the most common cause of hospitalization among adults over 65. Over 60% of patients die within 10 years of first onset of symptoms. The objective of this study is to determine the effectiveness of self-management interventions on hospital readmission rates, mortality, and health-related quality of life in patients diagnosed with heart failure.METHODS: The study is a systematic review of randomized controlled trials. The following data sources were used: MEDLINE (1966-11/2005), EMBASE (1980-11/2005), CINAHL (1982-11/2005), the ACP Journal Club database (to 11/2005), the Cochrane Central Trial Registry and the Cochrane Database of Systematic Reviews (to 11/2005); article reference lists; and experts in the field. We included randomized controlled trials of self-management interventions that enrolled patients 18 years of age or older who were diagnosed with heart failure. The primary outcomes of interest were all-cause hospital readmissions, hospital readmissions due to heart failure, and mortality. Secondary outcomes were compliance with treatment and quality of life scores. Three reviewers independently assessed the quality of each study and abstracted the results. For each included study, we computed the pooled odds ratios (OR) for all-cause hospital readmission, hospital readmission due to heart failure, and death. We used a fixed effects model to quantitatively synthesize results. We were not able to pool effects on health-related quality of life and measures of compliance with treatment, but we summarized the findings from the relevant studies. We also summarized the reported cost savings.RESULTS: From 671 citations that were identified, 6 randomized trials with 857 patients were included in the review. Self-management decreased all-cause hospital readmissions (OR 0.59; 95% confidence interval (CI) 0.44 to 0.80, P = 0.001) and heart failure readmissions (OR 0.44; 95% CI 0.27 to 0.71, P = 0.001). The effect on mortality was not significant (OR = 0.93; 95% CI 0.57 to 1.51, P = 0.76). Adherence to prescribed medical advice improved, but there was no significant difference in functional capabilities, symptom status and quality of life. The reported savings ranged from 1300 to 7515 dollars per patient per year.CONCLUSION: Self-management programs targeted for patients with heart failure decrease overall hospital readmissions and readmissions for heart failure.