| BackgroundChronic heart failure(CHF) is the main syndrome caused by different organic causes.CHF has become one of the 21 st century medical challenges because its high rate of prevalence,high rate of short-term readmission,heavy medical burden,multiple complications and poor prognosis.Standard management outside of the hospital is an effective way to improve the prognosis of CHF,the model of CHF management by GP leading,specialized doctor guiding,and community centering which means forming a multidisciplinary team,has become the best management mode of CHF in abroad.The main management of CHF is implemented in tertiary hospital in our country,it is unable to find the change of patients condition in time and deal with complications,In recent years, although some communities began to manage patients with CHF, and got certain achivement,the management methods have not been popularized.This subject plans to build a management composes of GPs,patients and their families,GPs provide comprehensive management,after 2years,we will evaluate the effect of management,the purpose is to provide a reference for our country in exploring CHF mangement mode in community.ObjectiveIn order to study the effect of managing CHF by GPs,the finally aim is to provide reference for the standardization management of CHF in community.Methods1,write the CHF doctor management manual and patient self-management manual.2,Setting the inclusion and exclusion criteria of CHF, according to the situation,the residential address and the willingness of the patients,management group and control group are divided, those who see a doctor in the community health service center of Yue tan or Fu xing hospita and live nearbyl, and are willing to take part in the research and regularly see a doctor are the management group, the rest of the CHF patients are the control group,collect the two groups patients’ demographic information, complications, CHF medications, blood routine examination,biochemical examination and echocardiographic data.3,Form a management team composing of general practitioner, patients and their families,provide self-managment manual,health education,personalized guidance,comprehensive management based on self management which including monitoring their complications such as hypertension,coronary heart disease, diabetes,chronic kidney disease and so on to the management group,follow up regularly;the control group patients are managed according to daily work.4,Two years later, collect the two groups, data again, including echocardiography results, test indicators, complication controlling, the rate of CHF guidelines recommended medications obeying, numebers of losing to follow-up, the total of death and the death date, the cause of death, etc.5,Sort data, using SPSS 17.0 statistical software for statistical analysis.Using X±S to stand for the quantitative data, adopting T test as the method of statistic analysis,using Z test for the non-normal distribution data;Using percentage to stand for the quantitative data, using chi-square test for the distribution between two groups;Using Kaplan Meier curve to stand for survival analysis, comparing the two groups with Log- Rank test; Using Cox regression analysis to analyse the multiple factors(if p<0.2,variables considered into the equation).If P<0.05,the results are statistically significant.Results1,A total of 261 patients with CHF conform to the standard, 122 for management group,139 for control group, the control group patients are older than the management group on average(p=0.012);Two groups of patients were combined a variety of diseases such as hypertension, coronary heart disease, the hypertension prevalence rate in management group is higher than the control group(p = 0.044);The level of albumin(p = 0.001), diuretics(p = 0.004) and digoxin(p = 0.000) taking rate in control group is lower than the management group;The number of losing to follow-up was 26(10.0%),a total of 75(28.7%) died during the study,,the mortality rate in control group was significantly higher than the management group(p=0.006);The main type of death in management group is cardiac death(10 people,40%), however,the result is infectious death(22 people, 44%) in control group.2,After two years, the average stand of blood sugar(p=0.011),total cholesterol(p=0.014), low density lipoprotein(p=0.006), hemoglobin(p=0.026), left ventricular ejection fraction(p>0.05), albumin(p>0.05), the level of glomerular filtration rate(p >0.05) in managment group decreased, the utilization of beta-blockers(p = 0.043)increased;In the control group,blood urea nitrogen(p=0.001),serum creatinine(p>0.05) increased on average, hemoglobin(p=0.001), left ventricular ejection fraction(p>0.05), albumin(p>0.05), the level of glomerular filtration rate(p>0.05) decreased on average, the taking of ACEI/ARB declined(p=0.001);Blood urea nitrogen in management group is lower than the control group(p=0.014), glomerular filtration rate(p=0.047), albumin(p=0.000), ACEI/ARB(p=0.005), beta blockers(p=0.007),digoxin(p=0.002) taking rate is higher than the control group.3,The average survival time is higher in management group than in control group(p=0.001);Cox regression found that the death risk in dead patients caused by cardiac factors increased with older age(p=0.019),higher level of blood sugar(p=0.010), however,the risk decreased as the levels of LVEF(p= 0.001),HDL-C(p=0.042) elevated and the using of beta blockers(p=0.007);For those dead patients caused by infectious factors,the death risk increased with older age(p=0.001),higher serum creatinine(p=0.042), the history of chronic obstructive pulmonary disease(p=0.016), cerebral infarction(p=0.020) and managing in conrol group(p=0.009) also increased risk of death;For those patients caused by other factors,the death risk increased with older age(p=0.038), however,declined with higher level of LVEF(p=0.021).ConclusionsCHF patients often have many complications, those who managed by GPs can achieve better medication compliance, 2 years, prognosis, especially better controlled in infectious death, blood glucose, blood lipid, etc, but less effect achieved in improving cardiac function, renal function, albumin, hemoglobin, this may be related to the high rate of short-term mortality in patients with CHF, in the meanwhile, the study found that the death risk of patients increased with aging, complication and so on,this suggests that the management leaded by GPs need to be more comprehensive in the future, further study may be needed to confirm the result. |
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