院外多学科干预随访对慢性心力衰竭预后的影响

Multidisciplinary intervention follow-up and outcomes in chronic heart failure outpatients

目的：探讨慢性心力衰竭（心衰）患者通过院外多学科干预随访对改善心衰预后的影响。方法：选择在我院心内科就诊的符合入组标准的慢性心衰患者171例,随机分为干预组和对照组,干预组给予多学科干预随访管理模式;对照组未按上述随访方案管理,患者自行随访就诊。从入组开始随访12个月,主要终点事件为心衰恶化再住院或全因死亡,分析2组与终点事件的关系。结果：入组时2组基础治疗用药无显著差异（均P〉0.05）;12个月随访时,干预组β受体阻滞剂、血管转换酶抑制剂（ACEI）和醛固酮拮抗剂的用药比例均明显提高,而地高辛和钙拮抗剂（CCB）比例有所下降,经组内及组间比较差异均有统计学意义（P〈0.05）;干预组38例（43.2%）和对照组51例（61.4%）患者发生主要终点事件[风险比（HR）=0.629,95%可信区间（CI）：0.412~0.958,P=0.031];与对照组比较,干预组有较低的全因入院率（HR=0.604,95%CI：0.405~0.900,P=0.013）,心衰病死率（HR=0.486,95%CI：0.244~0.968,P=0.04）和心衰恶化再住院率（HR=0.355,95%CI：0.17~0.744,P=0.006）。结论：对慢性心衰患者进行院外多学科干预随访可明显减少患者的再住院率和心衰死亡风险。

Objective：To evaluate the effect of multidisciplinary intervention follow-up on outcomes in chronic heart failure outpatients.Method：A total of 171 patients who were admitted with chronic heart failure in our hospital,were randomly assigned to intervention group with multidisciplinary intervention follow-up or matching control group with usual follow-up.Patients were followed up 12 months.The primary end point of this study was the composite of death from all causes or hospital addmission for heart failure.The difference of endpoint events between intervention and control group during 12-month follow-up after discharged was analyzed.Result：There was no statistically significant difference in drug intaking before patients join the groups（P〉0.05）.At 12 months,more patients in the intervention group than the control group had started ACE inhibitor/ARB,beta-blocker and aldosterone receptor antagonist,stopped digoxin and calcium channel blocker.There was significant difference within or between groups（P〈0.05）.38（43.2%）patients in intervention group and 51（61.4%）patients in control group had a primary endpoint event（HR=0.629,95%CI：0.412~0.958,P=0.031）.The intervention group had fewer readmissions for any reason（HR=0.604,95%CI：0.405~0.900,P=0.013）,fewer deaths due to heart failure（HR=0.486,95%CI：0.244~0.968,P=0.04）,and fewer admissions for heart failure（HR=0.355,95%CI：0.17~0.744,P=0.006）.Conclusion：Multidisciplinary intervention follow-up can reduce the hospital readmission and decreases deaths due to heart failure.