门诊性急性心力衰竭护理的有效性:试点随机对照试验
K Y K Wong1,2, D A Hughes3, M Debski1
1Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
Acta cardiologica
|September 11, 2023
概括
急性心力衰竭 (AHF) 的门诊治疗在试点研究中显示出前景,患者在医院外度过了更多的天,并报告了改善的幸福感. 与住院护理相比,这种方法也显示出了显著的成本节约.
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
- 临床试验 临床试验
背景情况:
- 住院治疗急性心力衰竭 (AHF) 具有10%的显著死亡风险.
- 观察性研究表明,门诊管理 (OPM) 可能对AHF有效.
- 进行了一项试点随机对照试验 (RCT),将OPM与标准住院管理 (IPM) 进行比较.
研究的目的:
- 为了比较OPM与IPM在需要静脉注射尿剂治疗的AHF患者中的有效性.
- 评估全因死亡率,活着和出院日数 (DAOH),生活质量,心理健康和希望分数.
- 评估OPM与IPM相比的成本效益.
主要方法:
- 一个试点RCT随机分配AHF患者到IPM或OPM.
- 数据收集包括全因死亡率,DAOH,生活质量,心理健康和60天的希望得分.
- 经济分析使用引导式分析计算了NHS的平均成本节约.
主要成果:
- 60天后OPM和IPM组之间所有原因死亡率没有统计学上显著的差异 (2/13对2/11).
- 在OPM组累计更多的DAOH (59对47天,p=0.13) 和有较少的再入院 (6对2,p=0.31).
- OPM与改善的总福利得分 (p=0.04) 和平均每位患者2658英的成本节省有关.
结论:
- 对AHF患者的OPM导致更多的活出医院的日子,尽管在这个试点研究中没有统计学意义.
- OPM受到患者和护理人员的青,从而改善了心理健康和大大节省了成本.
- 这项试点研究支持进一步调查OPM作为选择AHF患者的IPM可行的替代方案.
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