对慢性心力衰竭患者进行远程医疗监控： 一项前瞻性随机研究

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论证。慢性心力衰竭是国家医疗系统的主要问题之一。电子医疗可用于提高医疗质量，降低住院率和死亡率。

目的是研究远程医疗监控对慢性心力衰竭患者的死亡率、再次住院次数以及临床和功能状态的影响。

材料和方法。这项前瞻性、对照、随机研究于 2020 年 12 月至 2022 年 12 月在 Central City Hospital №20（叶卡捷琳堡）进行。确诊为慢性心力衰竭的患者通过信封法随机分为三组：第一组——电话防治所随访组（n=58），第二组——俄罗斯医疗平台 Medsenger 上的防治所随访组（n=52），第三组——综合医院心脏病专家面对面标准随访组（n=103）。所有患者在加入研究时以及 3、6 和 12 个月时都接受了 NT-proBNP 浓度和超声心动图检查。主要和次要终点的发生情况在参考点进行评估。统计处理使用 Stata 14 和 jamovi 程序进行。

结果。共有 213 人参加了这项研究。就基本人口统计和临床特征而言，所有三组均具有可比性。远程随访（第 1 组和第 2 组）比面对面随访（第 3 组）更能降低 3 个月和 12 个月的心血管死亡 率（为 3 个月：机会比率 2.73，95% 置信区间 1.1-7.39；P=0.042），（为 12 个月：机会比率 2.1， 95% 置信区间 1.1-3.7；P=0.027）。在 12 个月的综合主要终点也观察到了获益（机会比率 2.1，95% 置信区间 1.1-5.6；P=0.015）。

与面对面随访相比，使用 Medsenger 平台在 3 个月后发生合并次要终点事件方面（机会比率 1.39，95% 置信区间 0.19-0.81；P=0.011），在随访 12 个月时，由护士进行结构化电话访谈前，心血管死亡率方面（机会比率 0.177，95% 置信区间 0.06-0.487；P=0.021）和合并次要终点事件的发生率方面（机会比率 0.427，95% 置信区间 0.189-0.964；P=0.041）更具优势。

使用 Medsenger 平台后，左心室射血分数从基线的 47% 增加到 12 个月后的 55%（P=0.004）。3 个月后，NT-proBNP 浓度从 817 pg/ml 降至 582 pg/ml（P<0.001），12 个月后降至 233 pg/ml（P<0.001）。

结论。制定远程监控协议可能是替代传统的面对面随访慢性心衰患者的一个好办法，从而改善临床和功能性健康结果。

作者简介

Anna V. Isaeva

Ural State Medical University

Email: av_isaeva_cgb20@mail.ru
ORCID iD: 0000-0003-0634-9759
SPIN 代码: 5178-6596

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Ekaterinburg

Alexandra E. Demkina

Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies

Email: ademkina@bk.ru
ORCID iD: 0000-0001-8004-9725
SPIN 代码: 4657-5501

MD, Cand. Sci (Medicine)

俄罗斯联邦, Moscow

Anton V. Vladzymyrskyy

Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies

Email: a.vladzimirskiy@npcmr.ru
ORCID iD: 0000-0002-2990-7736
SPIN 代码: 3602-7120

MD, Dr. Sci. (Medicine)

俄罗斯联邦, Moscow

Boris V. Zingerman

iPat LLC

Email: boriszing@gmail.com
ORCID iD: 0000-0002-1855-1834
SPIN 代码: 5914-9174
俄罗斯联邦, Moscow

Anna N. Korobeynkova

Center of Cardiology and Neurology

编辑信件的主要联系方式.
Email: anna_best2004@mail.ru
ORCID iD: 0000-0002-8934-7021
SPIN 代码: 9728-9583

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Kirov

Alexandr N. Bykov

Sverdlovsk Regional Hospital 1

Email: sashacor83@yandex.ru
ORCID iD: 0000-0003-0787-7908
SPIN 代码: 6423-7610

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Ekaterinburg

Olga G. Smolenskaya

Ural State Medical University

Email: osmolenskaya@mail.ru
ORCID iD: 0000-0002-0705-6651
SPIN 代码: 5443-9382

Dr. Sci. (Medicine), Professor

俄罗斯联邦, Ekaterinburg

参考

  1. Tereshchenko SN, Galyavich AS, Uskach TM, et al. Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2020;25(11):40–83. EDN: LJGGQV doi: 10.15829/1560-4071-2020-4083
  2. Mareev VYu, Fomin IV, Ageev FT, et al. Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(6S):8–158. EDN: XUAREL doi: 10.18087/cardio.2475
  3. Vladzimirskii AV, Morozov SP, Urvantseva IA, Kovalenko LV, Vorob›ev AS. Application of telemedicine technologies in cardiology. Surgut: Surgut State University; 2019. (In Russ). EDN: IKCWRK
  4. Vladzimirskii AV, Lebedev GS. Telemedicine. Moscow: GEOTAR-Media; 2018. (In Russ). EDN: YMURZR
  5. Vladzimirskii AV. Telemedicine in cardiology: opportunities and evidence. Zamestitel’ glavnogo vracha. 2016;(8):80–89. (In Russ). EDN: WFLUGF
  6. Veenis JF, Radhoe SP, Hooijmans P, Brugts JJ. Remote Monitoring in Chronic Heart Failure Patients: Is Non-Invasive Remote Monitoring the Way to Go? Sensors (Basel). 2021;21(3):887. doi: 10.3390/s21030887
  7. Inglis SC, Clark RA, Dierckx R, Prieto-Merino D, Cleland JGF. Structured telephone support or non-invasive telemonitoring for patients with heart failure. Cochrane Database Syst Rev. 2015;(10). doi: 10.1002/14651858.CD007228.pub3
  8. Boytsov SA, Ageev FT, Blankova ZN, Svirida ON, Begrambekova YuL. Guidelines for nurses and patients with chronic heart failure. Cardiovascular Therapy and Prevention. 2021;20(1):283–306. EDN: WNIVZB doi: 10.15829/1728-8800-2021-2754
  9. Bavrina AP. Basic concepts of statistics. Meditsinskii al’manakh. 2020;(3):101–111. EDN: PUMGMM
  10. Arzamasov KM, Bushuev VO, Vladzymyrskyy AV, et al. Examination of a cardiac patient, by using carotid artery ultrasound screening: possibilities of telemedicine. Vrach. 2023;34(4):39–45. EDN: LRZKEW doi: 10.29296/25877305-2023-04-08
  11. Jiménez-Marrero S, Yun S, Cainzos-Achirica M, et al. Impact of telemedicine on the clinical outcomes and healthcare costs of patients with chronic heart failure and mid-range or preserved ejection fraction managed in a multidisciplinary chronic heart failure programme: A sub-analysis of the iCOR randomized trial. J Telemed Telecare. 2020;26(1-2):64–72. doi: 10.1177/1357633X18796439
  12. Clark RA, Inglis SC, McAlister FA, Cleland JGF, Stewart S. Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis. BMJ. 2007;334(7600):942. doi: 10.1136/bmj.39156.536968.55
  13. Mizukawa M, Moriyama M, Yamamoto H, et al. Nurse-led collaborative management using telemonitoring improves quality of life and prevention of rehospitalization in patients with heart failure. Int Heart J. 2019;60(6):1293–1302. doi: 10.1536/ihj.19-313
  14. Dierckx R, Inglis SC, Clark RA, Prieto-Merino D, Clelandet JGF. Telemedicine in heart failure: new insights from the Cochrane meta-analyses. Eur J Heart Fail. 2017;19(3):304–306. doi: 10.1002/ejhf.759
  15. Jiménez-Marrero S, Yun S, Cainzos-Achirica M, et al. Impact of telemedicine on the clinical outcomes and healthcare costs of patients with chronic heart failure and mid-range or preserved ejection fraction managed in a multidisciplinary chronic heart failure programme: A sub-analysis of the iCOR randomized trial. J Telemed Telecare. 2020;26(1-2):64–72. doi: 10.1177/1357633X18796439
  16. Galinier M, Roubille F, Berdague P, et al. OSICAT Investigators. Telemonitoring versus standard care in heart failure: a randomised multicentre trial. Eur J Heart Fail. 2020;22(6):985–994. doi: 10.1002/ejhf.1906
  17. Lynga P, Persson H, Hägg-Martinell A, et al. Weight monitoring in patients with severe heart failure (WISH). A randomized controlled trial. Eur J Heart Fail. 2012;14(4):438–444. doi: 10.1093/eurjhf/hfs023
  18. Boyne JJ, Vrijhoef HJ, Crijns HJ, et al. Tailored telemonitoring in patients with heart failure: results of a multicentre randomized controlled trial. Eur J Heart Fail. 2012;14(7):791–801. doi: 10.1093/eurjhf/hfs058
  19. Koehler F, Winkler S, Schieber M, et al. Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: the telemedical interventional monitoring in heart failure study. Circulation. 2011;123(17):1873–1880. doi: 10.1161/CIRCULATIONAHA.111.018473
  20. Pandor A, Gomersall T, Stevens JW, et al. Remote monitoring after recent hospital discharge in patients with heart failure: a systematic review and network meta-analysis. Heart. 2013;99(23):1717–1726. doi: 10.1136/heartjnl-2013-303811
  21. Chaudhry SI, Mattera JA, Curtis JP, et al. Telemonitoring in patients with heart failure. N Engl J Med. 2010;363(24):2301–2309. doi: 10.1056/NEJMoa1010029
  22. Umeh CA, Reddy M, Dubey A, et al. Home telemonitoring in heart failure patients and the effect of study design on outcome: A literature review. J Telemed Telecare. 2021;30(1). doi: 10.1177/1357633X211037197
  23. Drews TEI, Laukkanen J, Nieminen T. Non-invasive home telemonitoring in patients with decompensated heart failure: a systematic review and meta-analysis. ESC Heart Fail. 2021;8(5):3696–3708. doi: 10.1002/ehf2.13475
  24. Vladzymyrskyy AV. Systematic review: the messengers “WhatsApp®” and “Viber®” in a clinical routine. Zhurnal telemeditsiny i elektronnogo zdravookhraneniya. 2017;1(3):30–41 EDN: YPTUYR
  25. Pyrikova NV, Mozgunov NA, Osipova IV. Results of pilot remote monitoring of heart failure patients. Cardiovascular Therapy and Prevention. 2022;21(6):31–51. EDN: ROTHHY doi: 10.15829/1728-8800-2022-3151

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2. Fig. 1. Study of outpatient monitoring type (remote/face-to-face) of conical points after 3 months. CHF – chronic heart failure.

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3. Fig. 2. Impact of the type of outpatient monitoring (remote/face-to-face) on endpoints after 6 months. CHF – chronic heart failure.

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4. Fig. 3. Impact of the type of outpatient follow-up (remote/face-to-face) on endpoints after 12 months. CHF – chronic heart failure.

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5. Fig. 4. Dynamics of changes in left ventricular ejection fraction in patients of the study groups. Group 1 — telephone follow-up group (n=58); Group 2 — follow-up group on the Medsenger medical platform (n=52); Group 3 — standard follow-up group (n=103).

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6. Fig. 5. Dynamics of changes in NT-proBNP concentration in patients with different forms of dispensary observation: Remote DN - combined group of remote dispensary observation (1 and 2, n=110); in-person DN - standard dispensary observation group (n=103).

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7. Fig. 6. Dynamics of changes in NT-proBNP concentration in patients of the study groups: Group 1 — telephone follow-up group (n=58); Group 2 — follow-up group on the Medsenger medical platform (n=52); Group 3 — standard follow-up group (n=103).

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