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慢性心不全の視野を広げること:通常のケアと比較して,家での多学科的介入の効果
Sally C Inglis1, Sue Pearson, Suzette Treen
1University of Queensland, Faculty of Health Sciences, Brisbane, Queensland, Australia.
Circulation
|November 23, 2006
まとめ
慢性心不全の家庭内介入 (HBI) は,生存期間を大幅に倍増させ,通常のケアと比較して入院を減らす. この看護師主導のプログラムは,長期の患者管理に非常に費用対効果が高いことを証明しています.
科学分野:
- 心臓病学 心臓病学
- ゲリアトリクス ゲリアトリクス
- 医療サービス 研究 医療サービス
背景:
- 慢性心不全 (CHF) 管理プログラムの長期的な有効性は十分に確立されていません.
- CHFの高齢患者は,しばしば入院後に著しい罹病率と死亡率に直面します.
研究 の 目的:
- 慢性心不全の患者に対する看護師主導の,多分野,家庭での介入 (HBI) の長期的な影響を評価する.
- 典型的な寿命におけるHBIのアウトカムと通常の退院後のケア (UC) を比較する.
主な方法:
- CHFの入院後の297人の高齢患者を対象としたランダム化対照試験.
- 患者はHBI (n=149) またはUC (n=148) に割り当てられました.
- フォローアップは10年まで延長され,全因死亡率,無事生存率,再入院,費用対効果を評価した.
主要な成果:
- 平均生存期間は,UC (22ヶ月) と比較して,HBI群 (40ヶ月) でほぼ2倍であった (P<0.001).
- すべての原因による死亡率は,HBI (77%) とUC (89%) (調整RR 0.74) でより低かった.
- HBIは,長期のイベントフリー生存率と,患者"人当たりの再入院率と入院日数を1年に大幅に低下させました.
結論:
- 家庭での介入 (HBI) は,慢性心不全の自然な経歴を大幅に変化させます.
- HBIは,CHFの長期管理のためのコストと時間の効率的な戦略です.
- 看護師主導の多分野HBIは,高齢のCHF患者の生存率を向上させ,再発性入院を減少させます.
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