Comparison Of Clinical Efficacy Study In Patients With Heart Failure Strengthen Management Intervention And Conventional Management Intervention

Objective: To explore the efficacy on the outcome of patients with heart failure of strengthened and routinemanagement program for the cardiac function and long-term prognosis, compliance withtreatment, mortality, readmission rates, quality of life and health care coats.Methods:To randomize the200patients with heart failure which were hospitalized in Heart Center，TheFourth Affiliated Hospital of Medicine College，Shihezi University，Afrom March2011to March2012.(strengthened management group:100patients vs routine management group:100patients). To followed upthe patients for12months and then compare the treatment rusults of the two groups. To analyze the datawith statistical package for social science(SPSS)17.0software.Results:1. In strengthened management intervention group, the percent of patients with heart failure in NYHAclassification Ⅰand Ⅱclass,16(16%) than0(0%)and56(56%) than12(12%),is significantly increasedfrom baseline. the percent of patients with heart failure in NYHA classification Ⅲand Ⅳclass,21(2116%)than60(60%)and7(7%) than28(28%),is significantly decreased from baseline;Both differences werestatistically significant (P<0.05). In routine management intervention group, the percent of patients withheart failure in NYHA classification Ⅱclass,27(27.6%) than12(12.2%), is significantly increased frombaseline (P=0.003). the percent of patients with heart failure in NYHA classification Ⅰ,Ⅲand Ⅳclass, isimproved from baseline, and the difference was not significant (P>0.05). NYHA classification inpatients with heart failure of strengthened management intervention group was superior to conventionalmanagement routine group. The difference was statistically significant (P=0.001).2. In strengthened management intervention group, the average of FS, LVEDD, LVESD and LVEF wasimproved significantly from baseline (P<0.05), but the average of LAD was no significant difference frombaseline (P=0.147). In routine management intervention group, the average of LAD, FS, LVEDD, LVESDand LVEF was no significant difference compared wite baseline (P>0.05). In strengthened managementintervention group, the relevant parameters of cardiac function in patients with heart failure improvedsignificantly superior compared with baseline (P <0.05).3. In strengthened management intervention group, the level of lgNT-proBNP,3.47±0.29than3.55±0.33,improved significantly compared with routine management intervention group (P=0.04). After theintervention, the level of lgNT-proBNP in strengthened management intervention group improvedsignificantly superior compared with routine management intervention group, and the difference wasstatistically significant (P=0.04).4.In strengthened management intervention group, the physical score of patients with heart failureimproved significantly compared wite baseline（P=0.000）, but the physical score of patients in routinemanagement intervention group was no significant difference compared wite baseline (P=0.072). Themood rating of patients with heart failure improved significantly compared wite baseline in strengthenedand routine management intervention group (P=0.000). The life total score in strengthened management intervention group was significantly better than the routine management intervention group’s, and thedifference was statistically significant (P=0.002).5. In strengthened management intervention group, the percent of patients with heart failure in using ofangiotensin-converting enzyme inhibitors (ACEI), β-blockers, angiotensin receptor blocker (ARB),diuretics and aldosterone was significantly higher than the proportion of the routine managementintervention group, and the difference was statistically significant (P<0.05). The percent of using ACEIand β-blockers was significantly higher than that of the routine management intervention group, and theproportion of using ACEI and ACEI reached the target dose were significantly higher than that of theroutine management intervention group (P<0.05). It was no significant difference in the proportion ofdigoxin in the two groups (P=0.852).6. In strengthened management intervention group, the percent of patients with heart failure in weighing,measuring blood pressure, monitoring pulse, monitoring of urine output, strictly limiting sodium intake,strictly limiting water intake,policing edema and adhering to the exercise ratio was significantly higherthan that of the routine management intervention group, and the difference was statistically significant(P<0.05).7. In strengthened management intervention group, the percent of patients with heart failure inRe-hospitalization,6(6%) than14(14.3%), is significantly increased from the routine managementintervention group, and the number of re-hospitalization and the median number of days,in strengthenedmanagement intervention group, was significantly reduced than that of the routine managementintervention group (P<0.05). It was the strengthened management intervention group that can significantlyreduce the combined end point of mortality and incidence (P<0.05).8. In strengthened management intervention group, the cost of outpatient significantly increased than thatof,1819.91±207.19than797.13±425.97,the routine management intervention group (P=0.000). Thecost of hospitalization in strengthened management intervention group was lower than,9593.19±13557.35than12129.46±8140.31, that of the routine management intervention group, and the difference was notsignificant (P=0.089). The total medical costs saving of1513.49yuan in strengthened managementintervention group than that of the routine management intervention group, and the difference was notsignificant (P=0.309).Conclusions:1.Strengthened management interventions can significantly improve the heart function ofpatients with heart failure.2.Strengthened management interventions can significantly improve theprognosis of patients with heart failure.3.Strengthened management interventions can significantly reducethe mortality and readmission rates in patients with heart failure.4.Strengthened management interventionscan significantly improve the quality of life in patients with heart failure.5.Strengthened managementinterventions can significantly reduce the health care coast of patients with heart failure.