CAJ | 학술논문

目的评估强化门诊随访对慢性心力衰竭(心衰)患者预后及依从性的影响.方法回顾分析333例心衰患者门诊诊治情况,按其是否定期于心衰门诊随访,分为强化门诊随访组(随访组)和常规治疗组(常规组).调查患者预后、药物治疗情况、生活质量和医疗费用.结果随访组患者死亡与再住院率联合终点显著低于常规组(42.59%比66.67%,P<0.05);随访组患者死亡显著低于常规组(1.85%比14.35%,P<0.05);血管紧张索转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂的处方率、达靶剂量率显著高于常规组(86.79%比40.54%,P<0.05;17.92%比8.65%,P<0.05);β受体阻滞剂处方率、达靶剂量率显著高于常规组(89.62%比46.49%,P<0.05;17.92%比1.62%,P<0.05).随访组患者生活质量较高(明尼苏达心衰生活质量问卷评分30.7比37.7,P<0.05),平均医疗费用节省3821.51元.结论强化心衰门诊随访可以促进有循证医学证据的药物治疗,降低心衰患者的病死率和再入院率,改善生活质量并降低医疗费用.
목적 평고강화문진수방대만성심력쇠갈(심쇠)환자예후급의종성적영향.방법 회고분석333례심쇠환자문진진치정황,안기시부정기우심쇠문진수방,분위강화문진수방조(수방조)화상규치료조(상규조).조사환자예후、약물치료정황、생활질량화의료비용.결과 수방조환자사망여재주원솔연합종점현저저우상규조(42.59%비66.67%,P<0.05);수방조환자사망현저저우상규조(1.85%비14.35%,P<0.05);혈관긴장색전환매억제제/혈관긴장소Ⅱ수체길항제적처방솔、체파제량솔현저고우상규조(86.79%비40.54%,P<0.05;17.92%비8.65%,P<0.05);β수체조체제처방솔、체파제량솔현저고우상규조(89.62%비46.49%,P<0.05;17.92%비1.62%,P<0.05).수방조환자생활질량교고(명니소체심쇠생활질량문권평분30.7비37.7,P<0.05),평균의료비용절성3821.51원.결론 강화심쇠문진수방가이촉진유순증의학증거적약물치료,강저심쇠환자적병사솔화재입원솔,개선생활질량병강저의료비용.
Objective To test the efficacy of intensive clinic follow-up for outpatients with chronic heart failure (CHF) on outcome. Methods All patients diagnosed as CHF in our cardiac center between January 2007 to December 2008 were included in this study. The patients were divided into two intensive follow-up (IF) and usual care (UC) groups. Endpoints including death or rehospitalization, medication, the quality of life evaluated with Minnesota Living with Heart Failure Questionnaire ( MLHFQ) and hospital costs were analyzed with the data collected through hospital records or by telephone and post survey. Results A total of 333 patients were enrolled (108 patients in IF group and 225 in UC group). The mean follow-up duration was 454 days for IF group and 484 days for UC group. Mortality and readmission rate (66. 67% vs. 42.59%, P<0. 05) and mortality rate (14.35% vs. 1.85% , P<0. 05) were significantly higher in UC group than in IF group. The percentage of patients receiving ACEI/ARB (86. 79% vs. 40. 54% , P < 0. 05) and beta-adrenergic receptor blocker (89. 62% vs. 46. 49% , P < 0. 05 ) were higher in IF group than in the UC group. In addition, the percentage of patients receiving target dosage of drugs is also higher in IF group (ACEI/ARB17. 92% , BB17. 92% ) than in UC group ( ACEI/ARB8. 65% , BB1.62%, P<0.05, respectively). Furthermore, mean MLHFQ total score (30.7 vs. 37.7, P < 0.05) and hospital cost (3821.51 RMB less per patient in this period) were significantly lower in IF group than in UC group. Conclusion Intensive clinic follow-up for outpatients with CHF in HF clinic can improve evidencebased treatment, reduce the readmission and death rate, improve quality of life and save hospital cost