診療室での心不全の治療プロセスに関する対策と死亡率との関連性
Gregg C Fonarow1, Nancy M Albert, Anne B Curtis
1Department of Medicine, Ahmanson–UCLA Cardiomyopathy Center, Los Angeles, CA 90095-1679, USA. gfonarow@mednet.ucla.edu
Circulation
|April 6, 2011
まとめ
質の高い心不全 (HF) のケア対策は,よりよい生存率と関連しています. 薬剤と教育を含むHFプロセス対策の遵守は,患者の結果を改善し,品質評価を導くことができます.
科学分野:
- 心臓病学 心臓病学
- 医療サービス 研究 医療サービス
- クリニカルアウトカム
背景:
- 心不全 (HF) 外来患者のケア品質は,しばしばプロセスベースのパフォーマンス指標に依存します.
- これらのHFケアプロセス対策と臨床結果との関連性は,十分に評価されていません.
- この研究では,現在および新興の門診のHF対策と患者の生存率との関連が検討されています.
研究 の 目的:
- 既定および新規の外科医心不全 (HF) プロセス測定値と患者の生存率との関連性を評価する.
- HFケアガイドラインの遵守が臨床結果に影響を与えるかどうかを判断する.
- 患者介護の評価と改善におけるHFプロセス測定の有用性を評価する.
主な方法:
- 米国167の心血管外科室で24ヶ月間,エジェクション分数 (≤35%) が減少した15177人の患者をフォローアップした.
- 7つのHFプロセス測定 (4つの現在の, 3つの新興) と2つの要約測定基準の評価.
- プロセス測定値と24ヶ月の死亡率との関係を評価するための多変量分析.
主要な成果:
- 7つの特定のHFプロセス測定法 (ACE阻害剤/ARB,ベータブロッカー,AFの抗凝固薬,CRT,ICD,HF教育) は,独立して24ヶ月生存率の改善と関連していました.
- アルドステロン抗剤の使用は,生存率の改善と有意に関連しませんでした.
- 複合ケアサマリー測定では,生存と有意な関連性が示され,10%の改善は13%の死亡率の減少と相関していた (aOR,0.87).
結論:
- 現在および新興の室外心不全 (HF) プロセスの測定は,患者の生存率と正の関連性を示しています.
- これらのHF対策は,HFケアの質を評価し,向上させるための貴重なツールです.
- この発見は,臨床実務および品質改善イニシアチブにおけるこれらのプロセス測定法の使用を支持しています.
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