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Improvement in Kansas City Cardiomyopathy Questionnaire Scores After a Self-Care Intervention in Patients With Acute Heart Failure Discharged From the Emergency Department
Circulation: Cardiovascular Quality and Outcomes ( IF 6.9 ) Pub Date : 2021-09-24 , DOI: 10.1161/circoutcomes.121.007956
William B Stubblefield 1 , Cathy A Jenkins 2 , Dandan Liu 2 , Alan B Storrow 1 , John A Spertus 3 , Peter S Pang 4 , Phillip D Levy 5 , Javed Butler 6 , Anna Marie Chang 7 , Douglas Char 8 , Deborah B Diercks 9 , Gregory J Fermann 10 , Jin H Han 1 , Brian C Hiestand 11 , Christopher J Hogan 12 , Yosef Khan 13 , Sangil Lee 14 , JoAnn M Lindenfeld 15 , Candace D McNaughton 1 , Karen Miller 1 , W Frank Peacock 16 , Jon W Schrock 17 , Wesley H Self 1 , Adam J Singer 18 , Sarah A Sterling 19 , Sean P Collins 1
Affiliation  

Background:We conducted a secondary analysis of changes in the Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 over 30 days in a randomized trial of self-care coaching versus structured usual care in patients with acute heart failure who were discharged from the emergency department.Methods:Patients in 15 emergency departments completed the KCCQ-12 at emergency department discharge and at 30 days. We compared change in KCCQ-12 scores between the intervention and usual care arms, adjusted for enrollment KCCQ-12 and demographic characteristics. We used linear regression to describe changes in KCCQ-12 summary scores and logistic regression to characterize clinically meaningful KCCQ-12 subdomain changes at 30 days.Results:There were 350 patients with both enrollment and 30-day KCCQ summary scores available; 166 allocated to usual care and 184 to the intervention arm. Median age was 64 years (interquartile range, 55–70), 37% were female participants, 63% were Black, median KCCQ-12 summary score at enrollment was 47 (interquartile range, 33–64). Self-care coaching resulted in significantly greater improvement in health status compared with structured usual care (5.4-point greater improvement, 95% CI, 1.12–9.68; P=0.01). Improvements in health status in the intervention arm were driven by improvements within the symptom frequency (adjusted odds ratio, 1.62 [95% CI, 1.01–2.59]) and quality of life (adjusted odds ratio, 2.39 [95% CI, 1.46–3.90]) subdomains.Conclusions:In this secondary analysis, patients with acute heart failure who received a tailored, self-care intervention after emergency department discharge had clinically significant improvements in health status at 30 days compared with structured usual care largely due to improvements within the symptom frequency and quality of life subdomains of the KCCQ-12.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02519283.

中文翻译:

对从急诊室出院的急性心力衰竭患者进行自我护理干预后堪萨斯城心肌病问卷评分的改善

背景:我们对从急诊科出院的急性心力衰竭患者进行自我护理指导与结构化常规护理的随机试验,对堪萨斯城心肌病问卷 (KCCQ)-12 超过 30 天的变化进行了二次分析。方法:15 个急诊科的患者在急诊科出院时和 30 天时完成了 KCCQ-12。我们比较了干预组和常规护理组之间 KCCQ-12 分数的变化,并根据入组 KCCQ-12 和人口统计特征进行了调整。我们使用线性回归来描述 KCCQ-12 总分的变化,并使用逻辑回归来描述 30 天时具有临床意义的 KCCQ-12 子域变化。结果:有 350 名患者具有登记和 30 天的 KCCQ 总分;166 人分配给常规护理,184 人分配给干预组。中位年龄为 64 岁(四分位间距,55-70),37% 为女性参与者,63% 为黑人,入学时的中位 KCCQ-12 总分为 47(四分位间距,33-64)。与结构化的常规护理相比,自我护理指导可显着改善健康状况(改善 5.4 分,95% CI,1.12–9.68;P = 0.01)。干预组健康状况的改善是由症状频率(调整后的比值比,1.62 [95% CI,1.01-2.59])和生活质量(调整后的比值比,2.39 [95% CI,1.46-3.90])的改善推动的]) 子域。结论:在这项二次分析中,与结构化常规护理相比,在急诊科出院后接受量身定制的自我护理干预的急性心力衰竭患者在 30 天时的健康状况有临床显着改善,这主要是由于内部改善KCCQ-12 的症状频率和生活质量子域。注册:URL:https://www.clinicaltrials.gov;唯一标识符:NCT02519283。
更新日期:2021-10-20
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