基于家庭的护士主导的心力衰竭自我管理支持：一项随机对照试验。
完整摘要 · 中文译文
目的：评估由护士主导、按阶段定制的居家自我管理与随访方案对心力衰竭患者自我护理行为的影响。 背景：心力衰竭患者在专科评估后需要持续的教育、症状监测和自我管理支持。然而，前往结构化中心式心脏康复的途径可能受限。护士主导的居家模式可能有助于弥合专科心脏病护理与社区长期支持之间的差距，尤其是在无法获得康复服务的情况下。 方法：在这项平行组随机对照试验中，年龄40-75岁、纽约心脏协会I-III级心力衰竭且射血分数>30%的成人被分配接受12周居家方案或常规护理。干预措施由护士主导的居家访视和电话随访提供，适用于无法获得结构化中心式康复的临床稳定患者。干预组接受居家访视和电话随访（n = 32），而对照组接受常规护理（n = 31）。主要结局为自我护理行为。次要结局为生活质量、自我效能和体能。探索性临床结局为身体成分、射血分数和糖化血红蛋白（HbA1c）水平。 结果：在12周时，干预组的自我护理评分优于对照组（17.78 ± 2.93 对 40.00 ± 6.49）。次要结局也支持干预组，生活质量评分更好、自我效能评分更高，且6分钟步行距离更大。 步行距离。探索性临床结局显示，部分参数发生变化，包括射血分数和体液值。大多数干预参与者达到了跨理论模型的行动阶段，纽约心脏协会心功能分级显著改善。这一与初级卫生保健相关的基于家庭的模式与自我护理行为的改善相关，并在中心化康复不可用时，可能在心脏病专科评估后为心力衰竭患者提供连续性护理支持。 结论：该计划改善了心力衰竭患者的自我护理，并显示出在中心化心脏康复不可用时支持家庭自我管理的潜力。
完整摘要 · 英文原文
AIM: To evaluate the effect of a nurse-led, stage-tailored home-based self-management and follow-up programme on self-care behaviour in people with heart failure. BACKGROUND: People with heart failure require ongoing education, symptom monitoring, and self-management support after specialist assessment. However, access to structured centre-based cardiac rehabilitation may be limited. A nurse-led home-based model may help bridge the gap between specialist cardiology care and community-based long-term support, particularly where rehabilitation services are unavailable. METHODS: In this parallel-group randomized controlled trial, adults aged 40-75 years with New York Heart Association class I-III heart failure and ejection fraction >30% were allocated to a 12-week home-based programme or usual care. The intervention was delivered through nurse-led home visits and telephone follow-up for clinically stable patients who could not access structured centre-based rehabilitation. The intervention group received home visits and telephone follow-up (n = 32), while the control group received usual care (n = 31). The primary outcome was self-care behaviour. Secondary outcomes were quality of life, self-efficacy, and physical capacity. Exploratory clinical outcomes were body composition, ejection fraction, and HbA1c level. FINDINGS: At 12 weeks, the intervention group had better self-care scores than the control group (17.78 ± 2.93 vs 40.00 ± 6.49). Secondary outcomes also favoured the intervention group, with better quality of life scores, higher self-efficacy scores, and greater 6-minute walk distance. Exploratory clinical outcomes showed changes in some parameters, including ejection fraction and body-fluid values. Most intervention participants reached the Transtheoretical Model action stage, and New York Heart Association class improved significantly. This primary health care-relevant home-based model was associated with improved self-care behaviour and may support continuity of care for people with heart failure after specialist cardiology assessment when centre-based rehabilitation is unavailable. CONCLUSION: The programme improved self-care in people with heart failure and showed potential to support home-based self-management when centre-based cardiac rehabilitation was unavailable.