摘要
Abstract
Objective To evaluate the intervention effect of community-management with self-management on the treatment compliance and prognosis of discharged elderly patients with chronic heart failure(CHF).Methods 200 consecutive elderly patients with CHF discharged from Department of General Medicine,First Hospital of Qinhuangdao from 2014 to 2015 were enrolled and divided into the intervention group(100 cases) and control group(100 cases) by the random number table.Both community-management(services such as adjusting the medication and answering the questions of the patients and their family members during regular outpatient or home follow-ups provided by the local community health center) and self-management based on face-to-face health education before the discharge and self-management training offered during the home follow-up once a month by the local community health center were given to the intervention group.In contrast,the control group only received the conventional discharge guidance.The clinical follow-up was conducted 12 months later to investigate the incidence of cardiovascular events,use of drugs,as well as self-management level 〔 assessed by European Heart Failure Self-care Behavior Scale(EHFScBS)〕.Results The follow-up found that compared with the control group,the intervention group demonstrated lower incidence of cardiovascular events〔51.0%(51/100) vs 74.0%(74/100)〕,longer median event-free survival(356 d vs 180 d).Moreover,the intervention group presented a better prognosis(χ2=22.961,P<0.001) revealed by Log-rank test and higher rate of beta-blocker use〔89.6%(86/96) vs 78.4%(69/88),P<0.05〕.In addition,lower total EHFScBS score was found in the intervention group 〔(28.5± 4.4) vs(36.0±5.1),P<0.001〕.Multivariate Logistic regression analysis demonstrated that high NYHA class〔OR=2.259,95%CI(1.326,3.851)〕 and diabetes 〔OR=3.374, 95%CI(1.388,8.203)〕 were risk factors for cardiovascular events,while community-management with self-management〔OR=0.240,95%CI(0.114,0.505)〕 was a protective factor for cardiovascular events(P<0.05).Conclusion Community-management with self-management can significantly enhance the treatment compliance and self-care ability,reduce the risk of cardiovascular events and improve prognosis among elderly patients with CHF.关键词
心力衰竭/疾病管理/自我护理/老年人/预后/服药依从性Key words
Heart failure/Disease management/Self-care/Aged/Prognosis/Medication adherence分类
医药卫生
