Background: Shared medical appointments (SMAs) in heart failure (HF) are medical visits where several patients with HF meet with multidisciplinary providers at the same time for efficient and comprehensive care. It is unknown whether HF-SMAs can improve overall and cardiac health status for high-risk patients discharged with HF. Methods: A 3-site, open-label, randomized-controlled-trial was conducted. Participants within 12 weeks of HF hospitalization were randomized to receive either HF-SMA or usual HF clinical care (usual-care) on a 1:1 ratio. The HF-SMA team, which consisted of a nurse, nutritionist, psychologist, nurse practitioner and/or a clinical pharmacist, provided four 2-hour session HF-SMAs that met every other week for 8 weeks. Primary outcomes were the overall health status measured by EQ5D-VAS and cardiac health status by KCCQ, 180 days post-randomization. Results: Of the 242 patients enrolled (HF-SMA n=117, usual-care n=125, mean age 69.3±9.4 years, 71.5% white, 94.6% male), 84% of participants completed the study (n=8 HF-SMA and n=9 usual-care patients died). After 180 days, both HF-SMA and usual-care participants had similar and significant improvements from baseline in KCCQ, but only HF-SMA participants had significant improvements in EQ5D-VAS (mean change = 7.2 +/- 15.8 in HF-SMA versus -0.4 +/- 19.0 points in usual-care, p<0.001). Conclusion: Both HF-SMA and usual care in HF participants achieved significant improvements in cardiac health status, but only a team approach through HF-SMA achieved significant improvements in overall health status. A larger population and a longer follow-up time are needed in future studies to evaluate re-hospitalization and death outcomes.

中文翻译：

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心力衰竭住院后随访的共同医疗预约：一项随机对照试验

背景：心力衰竭 (HF) 的共享医疗预约 (SMA) 是指数名心力衰竭患者同时与多学科提供者会面，以获得高效、全面的护理的医疗就诊。目前尚不清楚 HF-SMA 是否可以改善因 HF 出院的高危患者的整体健康状况和心脏健康状况。方法：进行了一项三中心、开放标签、随机对照试验。HF 住院 12 周内的参与者按 1:1 的比例随机接受 HF-SMA 或常规 HF 临床护理 (usual-care)。HF-SMA 团队由护士、营养师、心理学家、执业护士和/或临床药剂师组成，提供了四次 2 小时的 HF-SMA 会议，每隔一周举行一次，持续 8 周。主要结局是随机化后 180 天通过 EQ5D-VAS 测量的整体健康状况和通过 KCCQ 测量的心脏健康状况。结果：在入组的 242 名患者中（HF-SMA n=117，常规护理 n=125，平均年龄 69.3±9.4 岁，71.5% 白人，94.6% 男性），84% 的参与者完成了研究（n=8 HF -SMA 和 n=9 例常规护理患者死亡）。180 天后，HF-SMA 和常规护理参与者在 KCCQ 中均较基线有相似且显着的改善，但只有 HF-SMA 参与者在 EQ5D-VAS 上有显着改善（HF-SMA 与对照组的平均变化 = 7.2 +/- 15.8）常规护理为 -0.4 +/- 19.0 分，p<0.001）。结论：HF-SMA 和 HF 参与者的常规护理均实现了心脏健康状况的显着改善，但只有通过 HF-SMA 的团队方法才实现了整体健康状况的显着改善。未来的研究需要更大的人群和更长的随访时间来评估再住院和死亡结果。