| Objective:To establish a remote transitional care model for patients after radiofrequency ablation of atrial fibrillation based on WeChat platform.A randomized controlled trial was conducted to evaluate the effect of the constructed distance nursing model,and to observe the effects on patients’ early recurrence,medication compliance,quality of life,anxiety and depression.Methods:Part 1:According to the clinical characteristics and nursing status of patients after atrial fibrillation radiofrequency ablation,we used the methods of literature analysis,expert consultation and preliminary experiment to construct a transitional care program for patients after atrial fibrillation radiofrequency ablation.Part 2:The construction of the remote transitional care mode was based on literature analysis and expert consultation,and in combination with the circumstance of current medical system.The research team confirmed the final version of remote transitional care model.A prospective randomized controlled trial was conducted to evaluate the effect of this mode in the management of atrial fibrillation after radiofrequency ablation and its impact on early recurrence after operation.From April 2019 to November 2021,140 patients who were ready for radiofrequency with the diagnosis of atrial fibrillation were selected.The samples were divided into control and intervention groups randomly,with 70 samples in each group.The control group were given routine outpatient followup and nursing intervention,and the intervention group was implemented the remote transitional care intervention for 12 weeks.The general data of patients were collected at T0(baseline).At T0,T1(4 weeks after discharge),T2(12 weeks after discharge),the quality of life(SF-36),medication compliance(Morisky medication compliance scale),anxiety status and Depression status were assessed by HAMA and HAMD scores,clinical outcomes(early recurrence of atrial fibrillation,unplanned readmission and all-cause mortality)were collected at the end of the research.SPSS26.0 and Prism9.0 were used for statistical analysis.Statistical methods such as descriptive analysis,independent sample t-test,rank sum test,chi-square test,generalized estimation equation analysis for repeated measures were used to evaluate the effects of remote transitional care,Cox regression analyses were carried out for the early AF recurrences after the AF ablation,adapt univariate and multivariate regression models to determine the impact of non-adjusted and adjusted intervention,P<0.05 showed that the difference was statistically significant.Results:Part 1:Through literature analysis and expert consultation,a transitional care program based on wechat was initially constructed after radiofrequency ablation of AF.The preliminary test results showed that patients in the transitional care group were improved in patients satisfaction(P<0.05),medication compliance(P<0.05),quality of life(P<0.05)and Hamilton Anxiety Scale score(P<0.05)in control group than the control group with significant difference.Part 2:1.A total of 140 patients with atrial fibrillation were included in this study,including 5 patients who refused operation due to personal reasons(3 in the control group and 2 in the intervention group).A total of 5 patients lost follow-up(5 in the control group and 0 in the intervention group),1 died(0 in the control group and 1 in the intervention group)because of other diseases.A sum of 125 patients were enrolled in the study after radiofrequency ablation of atrial fibrillation,59 controls and 66 interventions respectively.There are no significant differences in common data for two groups(P>0.05).2.At T0,T1 and T2 phase,no significant differences were found in the scores of all dimensions between the two groups,that is,the baseline was even,likewise no statistical differences were found in the scores of all dimensions between the two groups in T1(P>0.05).The scores of logical function(PF)and general health(GH)dimensions of the intervention group were higher than the control group(P<0.05).There were no significant differences in the other dimensional scores of the two groups(P>0.05).Comparing the quality of life of patients before and after intervention,it was found that the scores of all dimensions in T1 and T2 were higher than those in T0 baseline(P<0.05).3.The HAMA scores in T0,T1 and T2 stages were compared between the two groups.As a result,there were no significant differences in the two groups of T0 phase(P>0.05),i.e.,baseline was even.The scores were reduced more remarkably in the the intervention group at T1 and T2 phase than the control group(P<0.05).4.The HAMD scores of anxiety state in T0,T1 and T2 stages were compared between the two groups.No tatistical differences were found between the two groups in T0 baseline phase(P>0.05),that is,the baseline was comparable.Remarkable reduce of the scores were observed in both groups at T1 and T2 phse(P<0.05),but no significant differences were found between the two groups.5.The comparing the scores of Morisky medication compliance scale between the two groups in T0,T1 and T2,it was found that there was no significant difference in all dimensions between the two groups in T0 baseline(P>0.05),that is,the baseline was comparable.The scores of T1 and T2 intervention groups were higher than those of the control group(P>0.05).The Morisky scores of patients before and after intervention were compared within the group.There was no significant difference in the scores of T1,T2 and T0 in the control group(P>0.05),but the scores of T1 and T2 in the intervention group were lower than those in T0(P<0.05).6.During the follow-up of 12 weeks after RFC A,there was no significant difference in the early recurrence rate between the two groups(P>0.05).The risk factors of early recurrence of atrial fibrillation were analyzed.The adjusted multivariate analysis showed that the preoperative body mass index(BMI):[HR=1.166(95%CI:1.013～1.341)P=0.032],LVEF:[HR=1.166(95%CI:1.013～1.341)P=0.032],emotional function score(RE):[HR=1.166(95%CI:1.013～1.341)P=0.032]and mental health score(MH):[HR=1.166(95%CI:1.013～1.341)P=0.032]were correlated with early postoperative recurrence.Conclusion:1.The remote transitional care model based on WeChat platform meets the perioperative management needs of patients after radiofrequency ablation of atrial fibrillation under the current medical system.It is a new attempt to extend high-quality nursing service to community families through the internet platform in tertiary hospitals.It is scientific,repeatable and provides theoretical basis and reference value for the implementation of extended nursing for other chronic disease management in hospitals.2.The remote transitional care intervention based on WeChat platform can effectively improve the quality of life,medication compliance and anxiety of patients with atrial fibrillation after radiofrequency ablation but has no significant effect on the early recurrence rate after radiofrequency ablation.Further research is needed to exam the effect on clinical outcomes. |
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