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在心脏衰竭患者中, 自治干预是否有效? 一个个患者的数据元分析

Nini H Jonkman ¹, Heleen Westland ², Rolf H H Groenwold ²

¹From Department of Rehabilitation, Nursing Science and Sports (N.H.J., H.W., J.C.A.T., M.J.S.) and Julius Center for Health Sciences and Primary Care (R.H.H.G., A.W.H.), University Medical Center Utrecht, The Netherlands; Departments of Medical and Health Sciences and Department of Cardiothoracic Surgery (S.Å.), Department of Medical and Health Sciences, Division of Nursing Science (S.Å., A.S.), Department of Social and Welfare Studies (T.J.), and Department of Cardiology (A.S.), Linköping University, Sweden; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A.); British Heart Foundation, Glasgow, UK (L.B.); Department of Cardiology, Deventer Hospital, The Netherlands (P.W.F.B.-A.d.l.P., D.J.A.L.); Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill (D.A.D.); Department of Health Services, University of Washington, Seattle (P.L.H.); Department of Internal Medicine, University of Michigan, Ann Arbor (M.H.); Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands (G.I.J.M.K.); Institute of Nursing Science, University of Basel, Switzerland (M.E.L.); Department of Nursing Science, Jönköping University, Sweden (J. Mårtensson); Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña and INIBIC, A Coruña, Spain (J. Muñiz); Graduate School of Health Sciences, Hirosaki University, Aomori, Japan (H.O.); Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany (F.P.-K.); Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (M.W.R.); School of Nursing, University of Pennsylvania, Philadelphia (B.R.); Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (R.T.T.); and Department of Cardiology, University Medical Center Groningen, The Netherlands (D.J.v.V.). n.jonkman@umcutrecht.
²From Department of Rehabilitation, Nursing Science and Sports (N.H.J., H.W., J.C.A.T., M.J.S.) and Julius Center for Health Sciences and Primary Care (R.H.H.G., A.W.H.), University Medical Center Utrecht, The Netherlands; Departments of Medical and Health Sciences and Department of Cardiothoracic Surgery (S.Å.), Department of Medical and Health Sciences, Division of Nursing Science (S.Å., A.S.), Department of Social and Welfare Studies (T.J.), and Department of Cardiology (A.S.), Linköping University, Sweden; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A.); British Heart Foundation, Glasgow, UK (L.B.); Department of Cardiology, Deventer Hospital, The Netherlands (P.W.F.B.-A.d.l.P., D.J.A.L.); Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill (D.A.D.); Department of Health Services, University of Washington, Seattle (P.L.H.); Department of Internal Medicine, University of Michigan, Ann Arbor (M.H.); Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands (G.I.J.M.K.); Institute of Nursing Science, University of Basel, Switzerland (M.E.L.); Department of Nursing Science, Jönköping University, Sweden (J. Mårtensson); Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña and INIBIC, A Coruña, Spain (J. Muñiz); Graduate School of Health Sciences, Hirosaki University, Aomori, Japan (H.O.); Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany (F.P.-K.); Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (M.W.R.); School of Nursing, University of Pennsylvania, Philadelphia (B.R.); Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (R.T.T.); and Department of Cardiology, University Medical Center Groningen, The Netherlands (D.J.v.V.).

⁰From Department of Rehabilitation, Nursing Science and Sports (N.H.J., H.W., J.C.A.T., M.J.S.) and Julius Center for Health Sciences and Primary Care (R.H.H.G., A.W.H.), University Medical Center Utrecht, The Netherlands; Departments of Medical and Health Sciences and Department of Cardiothoracic Surgery (S.Å.), Department of Medical and Health Sciences, Division of Nursing Science (S.Å., A.S.), Department of Social and Welfare Studies (T.J.), and Department of Cardiology (A.S.), Linköping University, Sweden; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain (F.A.); British Heart Foundation, Glasgow, UK (L.B.); Department of Cardiology, Deventer Hospital, The Netherlands (P.W.F.B.-A.d.l.P., D.J.A.L.); Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill (D.A.D.); Department of Health Services, University of Washington, Seattle (P.L.H.); Department of Internal Medicine, University of Michigan, Ann Arbor (M.H.); Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands (G.I.J.M.K.); Institute of Nursing Science, University of Basel, Switzerland (M.E.L.); Department of Nursing Science, Jönköping University, Sweden (J. Mårtensson); Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña and INIBIC, A Coruña, Spain (J. Muñiz); Graduate School of Health Sciences, Hirosaki University, Aomori, Japan (H.O.); Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany (F.P.-K.); Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (M.W.R.); School of Nursing, University of Pennsylvania, Philadelphia (B.R.); Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (R.T.T.); and Department of Cardiology, University Medical Center Groningen, The Netherlands (D.J.v.V.). n.jonkman@umcutrecht.

Circulation +

2016年二月14日

在PubMed上查看摘要

概括

通过减少住院治疗和改善生活质量,自主治疗对心力衰竭患者有好处. 然而,对于中度/重度抑郁症患者,建议谨慎,因为干预措施可能会增加该组的死亡率.

科学领域

心脏病学
医疗服务研究
有耐心的自我管理

背景情况

自治干预在心力衰竭 (HF) 护理中很常见.
现有的试验结果不一致,子组的有效性不清楚.
本次元分析考察了高压自我管理干预的有效性和小组反应.

研究的目的

评估心力衰竭患者自我治疗措施的整体有效性.
确定特定的患者小组对这些干预措施的反应是否不同.
分析与HF相关的住院,全因死亡率和生活质量的影响.

主要方法

20个随机试验的个体患者数据元分析.
包括5624名心力衰竭患者.
使用混合效应和Cox比例危险模型与相互作用条款.

主要成果

自治干预降低了HF住院或因任何原因死亡的风险 (HR 0.80) 和HF住院风险 (HR 0.80).
观察到12个月HF相关生活质量的轻微改善 (SMD 0. 15).
在65岁以下的患者中,观察到对HF住院日的保护作用;然而,在中度/重度抑郁症患者中,自我治疗减少了生存期 (相互作用P=0. 01).

结论

自治干预对HF患者在住院和生活质量方面有好处.
调查结果不支持将干预措施限制在特定的子组.
由于死亡风险增加,建议对中度/重度抑郁症患者实施自我管理策略时谨慎.

关键词:

心脏衰竭进行元分析自己照顾

在心脏衰竭患者中, 自治干预是否有效? 一个个患者的数据元分析

概括

科学领域

背景情况

研究的目的

主要方法

主要成果

结论

关键词:

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在心脏衰竭患者中, 自治干预是否有效? 一个个患者的数据元分析

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概括

科学领域

背景情况

研究的目的

主要方法

主要成果

结论

关键词:

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