中国介入心脏病学杂志2024,Vol.32Issue(6) :311-316.DOI:10.3969/j.issn.1004-8812.2024.06.003

评价全生命周期管理体系对经导管主动脉瓣置换术患者预后的影响

Evaluation of life cycle management system on patients'prognosis after transcatheter aortic valve replacement

刘若云 刘然 戴枚芳 焦玥淼 李杨 常三帅 徐野 卢志南 赵丽 阴赪茜 宋光远
中国介入心脏病学杂志2024,Vol.32Issue(6) :311-316.DOI:10.3969/j.issn.1004-8812.2024.06.003

评价全生命周期管理体系对经导管主动脉瓣置换术患者预后的影响

Evaluation of life cycle management system on patients'prognosis after transcatheter aortic valve replacement

刘若云 1刘然 2戴枚芳 1焦玥淼 2李杨 2常三帅 2徐野 2卢志南 2赵丽 3阴赪茜 2宋光远2
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作者信息

  • 1. 北京体育大学运动人体科学学院,北京 100084;首都医科大学附属北京安贞医院心脏瓣膜病介入中心,北京 100011
  • 2. 首都医科大学附属北京安贞医院心脏瓣膜病介入中心,北京 100011
  • 3. 北京体育大学运动人体科学学院,北京 100084
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摘要

目的 以全生命周期管理理念为指导的智慧医疗体系在经导管主动脉瓣置换术(TAVR)后患者的长期管理中具有重要意义,旨在探讨这一管理体系在降低患者不良事件发生率、提供个体化医疗建议和改善生存预后方面的作用.方法 连续收集2021年6月至2023年8月首都医科大学附属北京安贞医院瓣膜病介入中心408例TAVR患者数据.2021年6月至2022年10月的患者为常规门诊复查组,2022年11月至2023年8月的患者为心脏监测组.通过Kaplan-Meier、Cox比例风险模型等进行分析,评估智慧医疗在术后长期管理的效果.结果 单因素Cox风险比例校正后,心脏监测组复合终点发生率显著低于常规门诊复查组(8.9%比17.7%,P=0.016);心脏监测组患者得到医疗救助的平均时间间隔明显缩短(3.02 h比97.09 h,P<0.001);使用心脏监测设备和智慧医疗平台对改善患者预后具有显著意义(HR 0.439,95%CI 0.244-0.790,P=0.006).结论 在现代互联网支持下,使用心脏监测设备能够有效预警TAVR术后患者的临床事件,改善术后的生存质量,为患者提供全面、持续、专业的医疗照护.

Abstract

Objective With the widespread of transcatheter aortic valve replacement(TAVR)in patients with severe symptomatic aortic stenosis(AS),the life-cycle management has become a major determinant of prognosis.Methods A total of 408 AS patients who underwent successfully TAVR from June 2021 to August 2023 were consecutively enrolled in Hospital Valve Intervention Center.Patients were assigned to the Usual Care(UC)group between June 2021 and October 2022,while patients were assigned to the Heart Multi-parameter Monitoring(HMM)group between November 2022 and August 2023.The primary endpoint was defined as composite endpoint within 6 months post-TAVR,including all-cause death,cardiovascular death,stroke/transient ischemic attack,conduction block,myocardial infarction,heart failure rehospitalization,and major bleeding events.Secondary endpoints were the time interval(in hours)from event occurrence to medical consultation or advice and patient satisfaction.Statistical analysis was performed using Kaplan-Meier and multivariable Cox proportional hazards models.Results The incidence of primary endpoint in HMM group was significantly lower than that in UC group(8.9%vs.17.7%,P=0.016),the driving event was the rate of diagnosis and recognition of conduction block.The average time intervals from event occurrence to receiving medical advice were 3.02 h in HHM group vs.97.09 h in UC group(P<0.001).Using cardiac monitoring devices and smart healthcare platforms provided significant improving in patients long-term management(HR 0.439,95%CI 0.244-0.790,P=0.006).Conclusions The utilization of cardiac monitoring devices and smart healthcare platforms effectively alerted clinical events and improved postoperative quality of life during long-term management post TAVR.

关键词

经导管主动脉瓣置换术/全生命周期管理/心脏多参数监测/远程智慧医疗

Key words

Transcatheter aortic valve replacement/Lifecycle management/Heart multi-parameter monitoring/Remote smart healthcare

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基金项目

北京安贞医院科创基金项目(AZ2022-CXZH-02)

出版年

2024
中国介入心脏病学杂志
北京大学

中国介入心脏病学杂志

CSTPCDCSCD
影响因子:1.224
ISSN:1004-8812
参考文献量6
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