Effects of intensive nursing care intervention outside hospital in patients with acute ST-segment elevation myocardial infarction undergoing emergency interventional therapy

doi:10.3877/cma.j.issn.2095-5782.2018.04.013

Abstract

Abstract:

Objective:

To observe the efficacy of multifactor intensive nursing intervention (telephone consultation, setting up outpatient nurses for coronary heart disease, health education, psychological care and guiding cardiac rehabilitation) in patients with acute ST-segment elevation myocardial infarction (STEMI) .

Methods:

We conducted an open-label, randomized and controlled trial at the 5th Affiliated Hospital of Sun Yat-Sen University. A total of 1920 patients with STEMI undergoing emergency interventional therapy were recruited and randomly divided into control group receiving usual care or intervention group receiving intensive nursing care. The patients (1874 cases) completed the follow-up of 24 months and the self-management abilities and clinical outcomes were reviewed.

Results:

Compared with usual-care group, intensive intervention group had better heart function and self-management abilities, including regular rehabilitation exercise, smoking cessation ratio, lipid success rate and self monitoring of blood sugar and blood pressure (P<0.001) . The use of secondary prevention drugs for CVD (statins, angiotensin-converting enzyme inhibitors, β-blockers and angiotensin II receptor antagonists) in intensive nursing group was higher than the usual-care group (P<0.001) , while the level of NT-pro-BNP, mortality and rehospitalization rates in intensive intervention group were lower than those of the usual-care group (P<0.05) .

Conclusions:

Multifactor intensive nursing care intervention is a good nursing care measure. It can help improve the self-management abilities and clinical outcomes for STEMI patients undergoing emergency interventional therapy.

Key words: Acute myocardial infarction, Nursing case intervention, Randomized controlled trial

Yonghua Liu, Tie Li, Shaoping Zhong, Xuehua Xie, Yingdong Ma. Effects of intensive nursing care intervention outside hospital in patients with acute ST-segment elevation myocardial infarction undergoing emergency interventional therapy[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2018, 06(04): 339-343.

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Figures/Tables 2

References 14

[1]	Wijeysundera HC,Machado M,Farahati F, et al. Association of temporal trends in risk factors and treatment uptake with coronary heart disease mortality, 1994-2005[J]. JAMA, 2010, 303(18):1841-1847.
[2]	Amsterdam EA,Wenger NK,Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines[J]. J Am Coll Cardiol, 2014, 64(24):e139-e228.
[3]	Li X,Murugiah K,Li J, et al. Urban-Rural Comparisons in Hospital Admission, Treatments, and Outcomes for ST-Segment-Elevation Myocardial Infarction in China From 2001 to 2011: A Retrospective Analysis From the China PEACE Study（Patient-Centered Evaluative Assessment of Cardiac Events）[J]. Circ Cardiovasc Qual Outcomes, 2017, 10(11): e003905.
[4]	Tra Jvander,Wulp I,Appelman Y, et al. Adherence to guidelines for the prescription of secondary prevention medication at hospital discharge after acute coronary syndrome: a multicentre study[J]. Neth Heart J, 2015, 23(4):214-221.
[5]	Yusuf S,Islam S,Chow CK, et al. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries（the PURE Study）: a prospective epidemiological survey[J]. Lancet, 2011, 378(9798):1231-1243.
[6]	Ibanez B,James S,Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation[J]. Rev Esp Cardiol（Engl Ed）, 2017, 70(12):1082.
[7]	Du X,Spatz ES,Dreyer RP, et al. Sex differences in clinical profiles and quality of care among patients with ST-segment elevation myocardial infarction from 2001 to 2011: insights from the China Patient-Centered Evaluative Assessment of Cardiac Events （PEACE）-retrospective study[J]. J Am Heart Assoc, 2016, 5（2）.
[8]	Raber L,Taniwaki M,Zaugg S, et al. Effect of high-intensity statin therapy on atherosclerosis in non-infarct-related coronary arteries（IBIS-4）: a serial intravascular ultrasonography study[J]. Eur Heart J, 2015, 36(8):490-500.
[9]	Teo K,Lear S,Islam S, et al. Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: The Prospective Urban Rural Epidemiology（PURE）study[J]. JAMA, 2013, 309(15):1613-1621.
[10]	Harbman P. The development and testing of a nurse practitioner secondary prevention intervention for patients after acute myocardial infarction: a prospective cohort study[J]. Int J Nurs Stud, 2014, 51(12):1542-1556.
[11]	Forsetlund L,Bjorndal A,Rashidian A, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes[J]. Cochrane Database Syst Rev, 2009, (2):CD003030.
[12]	Liem S,Sander HB,Oemrawsingh PV, et al. MISSION!: optimization of acute and chronic care for patients with acute myocardial infarction[J]. Am Heart J, 2007, 153(1):14 e11-11.
[13]	Aggarwal B,Shah GK,Randhawa M, et al. Utility of glycated hemoglobin for assessment of glucose metabolism in patients with ST-Segment elevation myocardial infarction[J]. Am J Cardiol, 2016, 117(5):749-753.
[14]	Lee WC,Fang HY,Chen HC, et al. Anemia: A significant cardiovascular mortality risk after ST-segment elevation myocardial infarction complicated by the comorbidities of hypertension and kidney disease[J]. PLoS One, 2017, 12(7):e0180165.

指标		普通护理组(n=1 070)	强化护理组(n=804)	统计量	P值
发病至冠脉血流开通时间(h)		5.6±1.8	5.7±1.6	t=-1.378	0.168
梗死相关动脉		?	?	χ²=2.406	0.359
?	前降支	452(42.2)	326(40.6)	?	?
?	回旋支	218(20.4)	149(18.5)	?	?
?	右冠状动脉	400(37.4)	329(40.9)	?	?
男性		580(54.2)	454(56.5)	χ²=0.950	0.330
年龄（岁）		65.0±12.7	64.3±10.2	t=1.238	0.216
吸烟		747(69.8)	569(70.8)	χ²=0.202	0.654
合并高血压		644(60.2)	518(64.4)	χ²=3.505	0.061
合并糖尿病		292(27.3)	247(30.7)	χ²=2.638	0.104
TC(mmol/L)		5.27±1.34	5.28±1.21	t=-0.168	0.866
LDL-C(mmol/L)		3.28±1.32	3.35±1.14	t=-1.214	0.225
肌酐(mmol/L)		90.60±43.91	88.82±31.36	t=0.988	0.323
使用ACEI/ARB		1 050(98.1)	797(99.1)	χ²=3.223	0.073
使用 β 受体阻滞剂		1 019(95.2)	773(96.2)	χ²=0.910	0.340
使用他汀类药物		1 070(100.0)	804(100.0)	χ²=0	1.000
左室舒张末内径(mm)		47.06±6.98	47.25±6.79	t=-0.596	0.551
左室射血分数(%)		56.14±4.75	56.54±5.37	t=-1.706	0.088
NT-pro-BNP(ng/L)		1 202.17±304.23	1 193.08±293.34	t=0.650	0.516

指标		普通护理组(n=1 070)	强化护理组(n=804)	统计量	P值
发病至冠脉血流开通时间(h)		5.6±1.8	5.7±1.6	t=-1.378	0.168
梗死相关动脉		?	?	χ²=2.406	0.359
?	前降支	452(42.2)	326(40.6)	?	?
?	回旋支	218(20.4)	149(18.5)	?	?
?	右冠状动脉	400(37.4)	329(40.9)	?	?
男性		580(54.2)	454(56.5)	χ²=0.950	0.330
年龄（岁）		65.0±12.7	64.3±10.2	t=1.238	0.216
吸烟		747(69.8)	569(70.8)	χ²=0.202	0.654
合并高血压		644(60.2)	518(64.4)	χ²=3.505	0.061
合并糖尿病		292(27.3)	247(30.7)	χ²=2.638	0.104
TC(mmol/L)		5.27±1.34	5.28±1.21	t=-0.168	0.866
LDL-C(mmol/L)		3.28±1.32	3.35±1.14	t=-1.214	0.225
肌酐(mmol/L)		90.60±43.91	88.82±31.36	t=0.988	0.323
使用ACEI/ARB		1 050(98.1)	797(99.1)	χ²=3.223	0.073
使用 β 受体阻滞剂		1 019(95.2)	773(96.2)	χ²=0.910	0.340
使用他汀类药物		1 070(100.0)	804(100.0)	χ²=0	1.000
左室舒张末内径(mm)		47.06±6.98	47.25±6.79	t=-0.596	0.551
左室射血分数(%)		56.14±4.75	56.54±5.37	t=-1.706	0.088
NT-pro-BNP(ng/L)		1 202.17±304.23	1 193.08±293.34	t=0.650	0.516

指标	普通护理组(n=1 070)	强化护理组(n=804)	统计量	P值
每周康复运动次数（次）	1.20±0.81	3.41±1.12	t=-49.358	<0.001
吸烟	712(66.5)	314(39.1)	χ²=140.001	<0.001
血脂达标	501(46.8)	614(76.4)	χ²=166.296	<0.001
自我监测血糖血压	728(68.0)	740(92.0)	χ²=155.836	<0.001
使用ACEI/ARB	729(68.1)	797(99.1)	χ²=291.714	<0.001
使用 β 受体阻滞剂	698(65.2)	781(97.2)	χ²=280.918	<0.001
使用他汀类药物	861(80.5)	804(100.0)	χ²=176.756	<0.001
左室舒张末内径(mm)	52.30±6.80	48.90±7.27	t=10.396	<0.001
左室射血分数(%)	47.03±4.01	59.00±5.78	t=-52.869	<0.001
NT-pro-BNP(ng/L)	1 608.31±380.44	803.47±298.19	t=54.055	<0.001
死亡	24(2.2)	6(0.7)	χ²=6.528	0.011
再入院	98(9.2)	44(5.5)	χ²=8.907	0.003

指标	普通护理组(n=1 070)	强化护理组(n=804)	统计量	P值
每周康复运动次数（次）	1.20±0.81	3.41±1.12	t=-49.358	<0.001
吸烟	712(66.5)	314(39.1)	χ²=140.001	<0.001
血脂达标	501(46.8)	614(76.4)	χ²=166.296	<0.001
自我监测血糖血压	728(68.0)	740(92.0)	χ²=155.836	<0.001
使用ACEI/ARB	729(68.1)	797(99.1)	χ²=291.714	<0.001
使用 β 受体阻滞剂	698(65.2)	781(97.2)	χ²=280.918	<0.001
使用他汀类药物	861(80.5)	804(100.0)	χ²=176.756	<0.001
左室舒张末内径(mm)	52.30±6.80	48.90±7.27	t=10.396	<0.001
左室射血分数(%)	47.03±4.01	59.00±5.78	t=-52.869	<0.001
NT-pro-BNP(ng/L)	1 608.31±380.44	803.47±298.19	t=54.055	<0.001
死亡	24(2.2)	6(0.7)	χ²=6.528	0.011
再入院	98(9.2)	44(5.5)	χ²=8.907	0.003

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