DASH-HF研究:对心力衰竭患者进行实用性质量改善随机实施试验,减少喷射分数
Aradhana Verma1, Gregg C Fonarow2, Jeffrey J Hsu2,3
1Department of Medicine (A.V., A.N.), David Geffen School of Medicine at the University of California, Los Angeles.
Circulation. Heart failure
|July 26, 2023
概括
基于仪表板的远程医疗干预并没有改善药物坚持或减少心力衰竭患者住院治疗. 需要进一步的研究来优化这种方法,以更好地管理心力衰竭.
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
- 数字健康数字健康
背景情况:
- 心力衰竭 (HF) 是住院和死亡的主要原因.
- 准则导向药物治疗 (GDMT) 显著降低了HF死亡率,但很难以最佳方式实施.
- 退伍军人事务部 (VA) 开发了一个HF仪表板,以加强门诊HF管理.
研究的目的:
- 评估主动仪表板导向远程医疗诊所在改善GDMT的使用和剂量对HF患者的有效性.
- 评估DASH-HF干预对药物优化和临床结果的影响.
主要方法:
- 一个随机的实用临床试验 (DASH-HF) 涉及300名心力衰竭退伍军人,其中包括心力衰竭和减少喷射率 (HFrEF) 和低于最佳的GDMT.
- 干预涉及主动的仪表板导向的远程医疗诊所.
- 主要结局是GDMT的复合得分,优化潜力得分 (OPS) 和6个月的结果. 二次结局包括HF住院和死亡率.
主要成果:
- 干预和常规护理组 (2.9对2.6) 在初级结局 (OPS) 中没有显著差异.
- 这项干预措施并没有显著减少与HF相关的住院病例或全因死亡率.
- 在二次结果中没有观察到显著的改善.
结论:
- 基于仪表板的临床干预措施没有改善药物优化 (OPS) 或减少HF患者的住院和死亡率.
- 需要更好的患者准和更密集的随访,以增强基于仪表板的诊所对提高HF质量的实用性.
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