改善准则遵守:一项随机试验,评估在心力衰竭中增加β抑制剂使用的策略
Maria Ansari1, Michael G Shlipak, Paul A Heidenreich
1Cardiology Division, San Francisco VA Medical Center, 4150 Clement St, San Francisco, Calif 94121, USA.
Circulation
|May 21, 2003
概括
对心力衰竭患者实施β-阻断剂指南最成功的是使用护士辅导员. 其他干预措施,如提供者教育和患者提醒,在改善遵守方面表现出有限的有效性.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 实施科学 实施科学
背景情况:
- 临床实践指南的传播往往无法提高遵守率.
- 这项研究评估了为心力衰竭 (HF) 患者实施β-阻断剂指南的干预措施.
研究的目的:
- 评估不同干预措施的有效性,以改善心力衰竭患者使用β-阻断剂的指导方针的遵守.
主要方法:
- 一项随机对照试验,包括169名高炎患者 (排泄分数<或=45%).
- 三种武器:控制 (提供者教育),提供者/患者通知 (提醒/信件) 和护士辅导员 (启动/标题).
- 主要结局:开始/持续服用β-阻断剂的患者比例.
主要成果:
- 护士辅导小组实现了67%的坚持27% (对照组) 和16% (提供者/患者通知) (P<0.001).
- 在护士辅导组 (43%) 与对照组 (10%) 和提供者/患者通知 (2%) 的目标β-阻断剂剂的比例较高 (P<0.001).
- 在不同组的不良事件中没有显著差异.
结论:
- 一个护士辅导者模型有效地在心力衰竭患者中实施了β-阻断剂指南.
- 提供者教育,临床提醒和患者教育对遵守指南的影响有限.
相关概念视频
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
2.1K
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
2.1K
Heart Failure Drugs: β-Blockers
3.0K
β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
3.0K
Heart Failure V: Medical Management
642
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
642
Heart Failure VI: Adjunct Therapies
635
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
635
Heart Failure VII: Nursing Interventions
807
The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
807
Cardiomyopathy V: Interprofessional Care
762
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
762

