Application Of Case Management Model In Cardiac Rehabilitation After PCI In CAD Patients

Objective(s):The purpose of this study is to construct a case management plan for patients with coronary heart disease after PCI,explore its effectiveness in improving risk factor control,cardiac function level,coronary heart disease self-management ability,and patient quality of life in patients with coronary heart disease,and provide reference for optimizing cardiac rehabilitation guidance.Methods:This study is based on the concept of case management.Through literature review,group members discussed the construction of a preliminary draft of post PCI case management plan for coronary heart disease patients.15 experts from relevant fields in Yunnan Province were selected for two rounds of expert consultation,and the final draft of post PCI case management plan for coronary heart disease patients was formed based on expert opinions.86 patients who met the inclusion and exclusion criteria in the cardiology department of a tertiary hospital in Kunming from January 2022.1 to August 2022.8 were selected as the research subjects.Using a random number table method,86 patients were randomly assigned to the control group and the experimental group.The experimental group provided behavioral guidance on medication,diet,exercise,psychology,and smoking cessation according to the five steps of case management.Five major prescriptions for coronary heart disease were pushed to the patients 1 week,2 weeks,and 1 month after discharge,and the patients were pushed through telephone We Chat and face-to-face communication were used to communicate with patients for more than 30 minutes to ensure that they followed the prescription correctly.The control group received routine cardiac rehabilitation guidance,and after 6 months of intervention,coronary heart disease risk factors,cardiac ultrasound results,coronary heart disease self-management ability,cardiac rehabilitation compliance,cardiovascular adverse events,and readmission rate were compared between the two groups of patients,Analyze the impact of case management mode applied to coronary heart disease patients after PCI on controlling coronary heart disease risk factors,improving patients’ cardiac function level,enhancing patients’ self-management ability,and cardiac rehabilitation compliance.Results:At the end of the intervention,a total of 84 patients completed all data collection during hospitalization and post hospital follow-up,with 41 in the experimental group and 43 in the control group.Six months after discharge,the risk factors of coronary heart disease(body mass index,systolic/diastolic blood pressure,fasting blood glucose,total cholesterol,low-density lipoprotein),cardiac color ultrasound results(left ventricular ejection fraction,cardiac output),coronary heart disease self-management score,cardiac rehabilitation compliance(6MWD,BMI,Morisky medication compliance scale,Pittsburgh sleep quality assessment scale score,nicotine dependence evaluation scale)The probability of cardiovascular events and changes in readmission rates.The results showed that: 1.The impact of case management mode on the risk factors of coronary heart disease: The results showed that there were significant differences in risk factors between the two groups of patients at admission and 6 months after discharge(P<0.05);2.The impact of case management mode on cardiac function of coronary heart disease:The left ventricular ejection fraction(LVEF)and cardiac output(CO)of patients in the two groups at admission and 6 months after discharge were statistically significant(P<0.05);3.The impact of case management mode on self-management ability: There is a significant difference in self-management behavior scores between the two groups at admission and 6 months after discharge: there is a significant difference in multiple indicators such as bad hobby management(P<0.05);4.The impact of case management mode on quality of life: 6 months after discharge,0out of 41 patients in the experimental group were re hospitalized,while 8 out of 43 patients in the control group were re hospitalized.The re hospitalization rate in the control group was significantly higher,and the difference was statistically significant(P<0.05);After intervention,there were no adverse cardiac events in the experimental group,while there were 8 cases in the control group,with statistically significant differences in data(P<0.05);5.The impact of case management mode on cardiac rehabilitation compliance: There was a significant difference in scores of 6MWD,BMI,Morisky medication compliance scale,Pittsburgh sleep quality assessment scale,and nicotine dependence assessment scale between the two groups of patients at admission and 6 months after discharge(P<0.05);The results of the control group showed that there were no statistically significant differences in risk factors,cardiac ultrasound results,self-management behavior scores for coronary heart disease,cardiac rehabilitation compliance,readmission rate,and adverse cardiac events between the patients at admission and 6 months after discharge(P>0.05).Conclusion(s):1.The case management model can effectively control the risk factors related to coronary heart disease patients,improve their heart function,enhance their disease self-management ability,improve their quality of life,and control medical costs.2.The case management model can effectively improve the compliance of coronary heart disease patients with cardiac rehabilitation after PCI,change their lifestyle,and return to society as soon as possible.