《心悸(心律失常-室性早搏)多民族医诊疗专家共识》临床问题与结局指标的收集与确定

Collection and Determination of Clinical Problems and Outcome Indicators of Expert Consensus on Clinical Application of Ethnic Medicine in the Treatment of Palpitation(Arrhythmia-premature Ventricular Complexes)

背景民族医药治疗室性早搏具有诸多优势,然而民族医药滥用的情况普遍,并且缺乏专属的临床用药推荐,因此规范民族医药诊疗室性早搏具有重要意义。目的构建《心悸(心律失常-室性早搏)多民族医诊疗专家共识》的临床问题及结局指标。方法问询专家为共识专家组,涵盖心血管、循证医学、药学领域的专家,心血管方面包括中医、藏医、蒙医、维吾尔医、傣医、朝鲜医、壮医等多民族医专家。基于文献和专家访谈报告,课题组检索中医、藏医、蒙医、维吾尔医、傣医、朝鲜医、壮医等多民族医治疗室性早搏的相关文献。于2023年4月对14位各民族医专家进行一对一线上访谈。整合访谈结果及专家经验,由共识指导委员会、工作组共同起草临床问题与结局指标初稿,并设计调查问卷。于2023年5—7月开展两轮问卷调查,并评价问卷的积极系数、集中程度、协调程度和信度。结果专家组具有多学科协作、权威性和地域代表性的特点。两轮德尔菲法积极系数为99.1%,5个背景问题的均分>4分且满分>40%,10个前景问题的均分>3.9分且满分比>35%,9个结局指标的均分>7分且满分比>30%,平均变异系数分别为14.9%、16.3%、17.6%。临床问题、结局指标的肯德尔和谐系数分别为0.267、0.316,χ^(2)检验P<0.05,Cronbach'sα系数分别为0.913、0.905,均>0.700,质量控制结果较理想,问卷设计可信度高。结论借助德尔菲法,构建《心悸(心律失常-室性早搏)多民族医诊疗专家共识》所需解决的临床问题及结局指标,为后续共识制定奠定了基础。

Background Ethnic medicine holds numerous advantages in the treatment of premature ventricular complexes(PVCs).However,there is a concerning trend of abuse of ethnic medicine,particularly in the absence of tailored clinical drug recommendations specifically designed for this purpose.Consequently,it is of crucial importance to standardize the diagnosis and treatment of PVCs within the context of ethnic medicine.Objective To establish the clinical problems and outcome indicators of the Expert Consensus on Clinical Application of Ethnic Medicine in the Treatment of Palpitation(Arrhythmia-Premature Ventricular Complexes).Methods The inquiring experts were members of the consensus expert group,encompassing experts in the fields of cardiology,evidence-based medicine,and pharmacology.Specifically,within cardiology,they comprised multi-ethnic medical experts in traditional Chinese medicine,Tibetan medicine,Mongolian medicine,Uyghur medicine,Dai medicine,Korean medicine,and Zhuang medicine.Drawing from the available literature and expert interview reports,the research team conducted a comprehensive search of relevant literature on the treatment of PVCs using various ethnic medical practices.In April 2023,a series of one-on-one online interviews were conducted with 14 multi-ethnic medical experts.Following the integration of the interview results and expert experiences,the consensus steering committee and working group jointly drafted the initial proposals for clinical questions and outcome indicators,subsequently designing a survey questionnaire.Between May and July 2023,two rounds of questionnaire surveys were conducted,rigorously evaluating the positivity,concentration,coordination,and reliability of the questionnaire responses.Results The expert panel was characterized by its multidisciplinary collaboration,authority,and geographical representation.The two rounds of the Delphi method yielded a positive coefficient of 99.1%.For the five background questions,the mean score was greater than 4,with the full scale exceeding 40%.For the ten prospective questions,the mean score was greater than 3.9,with the full scale surpassing 35%.Additionally,the nine outcome indicators achieved a mean score greater than 7,with the full scale exceeding 30%.The mean coefficient of variation for these metrics was 14.9%,16.3%,and 17.6%.The Kendall harmony coefficients for clinical questions and outcome indicators were 0.267 and 0.316.The chi-square test showed a P-value of less than 0.05.The Cronbach'sαcoefficients were 0.913 and 0.905,both exceeding 0.7,suggesting high reliability.Overall,the quality control results were satisfactory,indicating a high degree of credibility in the questionnaire design.Conclusion Utilizing the Delphi method,we have identified the clinical problems and outcome indicators that need to be addressed in the development of the Expert Consensus on Clinical Application of Ethnic Medicine in the Treatment of Palpitation(Arrhythmia-Premature Ventricular Complexes),laying a solid foundation for the subsequent formulation of the consensus.