一种新的护士主导的、多学科的、有指南指导的疾病强化管理方案提高了肺动脉高压患者的长期生存率

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung Pub Date : 2025-05-27 DOI:10.1016/j.hrtlng.2025.05.011

Jiajun Guo , Juan He , Jiaqi Wang , Yaodan Liang , Yangjie Li , Chen Chen , Bi Wen , Lidan Yin , Shoufang Pu , Ke Wan , Jie Wang , Weihao Li , Yuanwei Xu , Yuchi Han , Yucheng Chen

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引用次数: 0

摘要

背景虽然肺动脉高压（pulmonary hypertension， PH）患者的总体生存率在当今时代有所提高，但更好的肺动脉高压患者管理策略仍需进一步探索。在这里，我们提出了一种新的护士主导的、多学科的、有指南指导的疾病强化管理方案，并假设这种策略可以提高PH患者的总体生存率。方法前瞻性纳入患者，自愿分为强化管理组（IDM）和常规疾病护理组（CDC）。强化管理由护士领导并由多学科团队提供，包括患者教育、症状监测和患者依从性改善，每3个月进行一次仔细的门诊或住院评估，并在需要时开具药物处方。接受常规治疗的患者每年由初级心脏病专家的顾问和电话随访进行治疗。结果最终纳入413例PH患者。IDM组总生存率（p<0.001）和无事件生存率（p=0.008）均显著高于CDC组。在调整年龄和性别后，强化管理也是主要[全因死亡率，HR 0.378, 95% CI (0.214-0.668), p<；0.001]和复合终点[全因死亡率和再住院，HR 0.648, 95% CI (0.454-0.927), p=0.017]的独立保护性预测因子。在亚组分析中，IDM有利于延长高危情况（HR 0.283, 95% CI 0.125-0.641, p=0.002）和晚期右心室功能障碍患者的总生存期（HR 0.250, 95% CI 0.123-0.510, p<0.001）。结论护士主导、多学科、指导的疾病强化管理方案是提高PH患者总体生存和无事件生存的理想方法，特别是对于晚期PH患者。

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A novel nurse-led, multidisciplinary, and guideline-directed disease intensive management program improves long-term survival of pulmonary hypertension patients

Background

Although the overall survival of pulmonary hypertension (PH) patients improved in the current era, better management strategy for PH patients still needs further exploration.

Objectives

Here, we proposed a novel nurse-led, multidisciplinary, and guideline-directed disease intensive management program and hypothesized this strategy would improve the overall survival of PH patients.

Methods

Patients were prospectively enrolled and divided into the intensive management group (IDM) and the conventional disease care (CDC) group voluntarily. Intensive management was nurse-led and delivered by multidisciplinary teams, including patient education, symptoms monitoring, and patient adherence improvement with careful outpatient or inpatient assessment every 3 months and medicine prescription whenever needed. Patients with conventional care were treated by primary cardiologists’ consultants and telephone follow-ups every year.

Results

Overall, 413 PH patients were finally included. Both total survival (p<0.001) and event-free survival (p=0.008) of the IDM group were significantly higher than the CDC group. After adjustment of age and sex, intensive management was also an independent protective predictor for both primary [all-cause mortality, HR 0.378, 95% CI (0.214-0.668), p<0.001] and composite endpoints [all-cause mortality and re-hospitalization, HR 0.648, 95% CI (0.454-0.927), p=0.017]. In subgroup analysis, IDM was beneficial in prolonging the overall survival of patients in high-risk situations (HR 0.283, 95% CI 0.125-0.641, p=0.002) and with advanced RV dysfunction (HR 0.250, 95% CI 0.123-0.510, p<0.001).

Conclusion

Nurse-led, multidisciplinary, and guideline-directed disease intensive management program represented an ideal method to strengthen the overall and event-free survival of PH patients, especially for those in advanced stages of PH.

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来源期刊

Heart & Lung 医学-呼吸系统

CiteScore

4.60

自引率

3.60%

发文量

184

审稿时长

35 days

期刊介绍： Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders. The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.