老年慢性心力衰竭患者的远程管理效果

Telemedical intervention management in elderly patients with chronic heart failure

摘要:

目的 探讨远程管理对老年慢性心力衰竭患者预后的影响。方法 入选2014年6月至2018年12月解放军总医院第六医学中心老年医学科治疗的老年慢性心力衰竭患者256例,根据出院时间顺序分为远程管理组(125例)和常规管理组(131例)。采用SPSS 25.0软件对数据进行统计学分析。组间全因死亡分析采用Kaplan-Merier生存曲线。结果 中位随访时间为25.0(17.0～38.8)个月,随访期间全因死亡51例(19.9%),其中呼吸道感染死亡28例。全因死亡率远程管理组12.8%(16/125),常规管理组26.7%(35/131)。与常规管理相比,远程监管能降低患者全因死亡率(HR＝0.403,95%CI 0.210～0.773；P＝0.006)。远程管理组心血管疾病死亡率[4.0%(5/125)]及呼吸道感染死亡率[7.2%(9/125)]均低于常规管理组[9.9%(13/131),14.5%(19/131)],但差异无统计学意义(P＞0.05)。2组全因再住院次数比较,差异无统计学意义(P＞0.05)。远程管理组全因再住院时间、心血管病再住院时间中位数(49.0,12.0d),均高于常规管理组(28.0,0.0d),差异有统计学意义(P＜0.05)。结论 远程管理能降低老年慢性心力衰竭患者全因死亡率,但增加全因再住院时间、心血管病再住院时间。

Abstract:

Objective To explore the effect of remote patient management on the prognosis of elderly patients with chronic heart failure. Methods A total of 256 elderly patients with chronic heart failure treated in the geriatric department of our Sixth Medical Center from June 2014 to December 2018 were enrolled, and according to their hospital discharge order, they were divided into a remote management group (n=125) and a routine management group (n=131). SPSS statistics 25.0 was used to perform the statistical analysis. Kaplan-Merier survival curve was performed for all-cause death analysis between groups. Results During a median follow-up time of 25.0 (17.0～38.8) months, 51 patients (19.9%) experienced all-cause death, including 28 deaths due to respiratory infections. All cause mortality was 12.8% (16/125) in the remote management group and 26.7% (35/131) in the routine management group. Compared with the conventional management, telemonitoring could reduce patients′ all-cause mortality (HR=0.403,95%CI 0.210-0.773; P=0.006). The death rates of cardiovascular disease and respiratory infection were lower in the remote management group[4.0%(5/125),7.2%(9/125)] than the routine management group [9.9%(13/131)14.5%(19/131)], though none of the differences were statistically significant(P>0.05). There was no significant difference in the incidence of all-cause rehospitalizations between the two groups (P>0.05). The median time of all-cause rehospitalization and cardiovascular rehospitalization in the remote group were 49.0 and 28.0 d, respectively, which were higher than those of the routine group(28.0 and 0.0 d), respectively, with obvious difference between the two groups (P<0.05). Conclusion Remote patient management could reduce all-cause mortality but increase all-cause rehospitalization and cardiovascular rehospitalization in elderly patients with chronic heart failure.