https://scholars.lib.ntu.edu.tw/handle/123456789/524405
標題: | Edema index-guided disease management improves 6-month outcomes of patients with acute heart failure | 作者: | Liu M.-H. Wang C.-H. Huang Y.-Y. Tung T.-H. CHII-MING LEE Yang N. Wang J.-S. Kuo L.-T. Cherng W.-J. |
關鍵字: | Disease management; Edema index; Heart failure; Prognosis | 公開日期: | 2012 | 卷: | 53 | 期: | 1 | 起(迄)頁: | 11-17 | 來源出版物: | International Heart Journal | 摘要: | The efficacy of heart failure (HF) management programs is compromised by the challenge of early identification of patients at imminent risk. Segmental multifrequency bioelectrical impedance analysis can generate an "edema index" (EI) as a surrogate for the body fluid status. In this study, we tested whether integration of EI-guided management improved the 6-month outcomes of HF patients under multidisciplinary care. In total, 159 patients with acute HF were randomized into control, case management (CM), and EI-guided CM (EI) groups (n = 53 in each group). In the EI group, a management algorithm was designed based on the measured EI. The analyzed endpoints included HF-related and all cause-related events during the 6-month follow-up period. In the 6 months, there were 11 (6.9%) deaths, 19 (11.9%) HFrelated rehospitalizations, and 45 (28.3%) all-cause-related rehospitalizations. Compared to the control (26.4%) and CM groups (15.1%), the EI group had a lower rate of HF-related death and rehospitalization (3.8%, P = 0.004). Multivariate analysis revealed that EI-guided management was an independent predictor of a lower HF-related event rate (hazard ratio = 0.15, 95%CI = 0.03~0.66, P = 0.012). Patients with a higher pre-discharge EI were older, had lower blood albumin and hemoglobin levels, and had a higher functional class and incidences of diabetes mellitus and chronic kidney disease. An increase in the pre-discharge EI by 0.001 increased the HF-related event rate by 6% (P = 0.002). Use of EI-guided management lowered this risk (P = 0.03). In conclusion, an EI-based HF management program demonstrated an eventlowering effect superior to traditional nurse-led multidisciplinary care in 6 months after an acute HF episode. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-84863232642&doi=10.1536%2fihj.53.11&partnerID=40&md5=80f6bbb30d6a0dc4693993d493754a0d https://scholars.lib.ntu.edu.tw/handle/123456789/524405 |
ISSN: | 1349-2365 | DOI: | 10.1536/ihj.53.11 | SDG/關鍵字: | albumin; angiotensin receptor antagonist; beta adrenergic receptor blocking agent; brain natriuretic peptide; dipeptidyl carboxypeptidase inhibitor; diuretic agent; hemoglobin; action potential; acute heart failure; adult; albumin blood level; article; body fluid; chronic kidney disease; controlled study; death; diabetes mellitus; drug efficacy; female; heart left ventricle ejection fraction; hemoglobin blood level; high risk patient; hospital readmission; human; incidence; major clinical study; male; patient identification; priority journal; treatment outcome; Aged; Algorithms; Edema; Electric Impedance; Female; Heart Failure; Humans; Male; Middle Aged; Prognosis; Severity of Illness Index |
顯示於: | 醫學系 |
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