Influence Of Network-based Self-management Plan On Cardiovascular Risk Factors And Self-efficacy Of Middle-aged And Young Patients With High Risk Of ASCVD

ObjectiveAtherosclerotic cardiovascular disease is the main cause of morbidity and mortality in China,and it is also a huge source of medical expenditure.Among the people with cardiovascular diseases,the number of young and middle-aged patients and deaths has increased most rapidly.In view of the rising incidence of ASCVD among young and middle-aged people,strengthening the prevention of high-risk groups of ASCVD among young and middle-aged people is the main means.However,it is common in China to pay more attention to treatment than prevention of cardiovascular diseases.This study explores the influence of self-management plan based on network centered on self-efficacy theory on cardiovascular risk factors,self-efficacy and anxiety and depression of high-risk patients aged 20-59 with ASCVD,and makes a preliminary evaluation on the intervention effect.Methods210 young and middle-aged high-risk patients with ASCVD from September 2020 to November 2021 were selected from the General Medicine Department of Henan Provincial People’s Hospital,Beixia Street Community Health Service Center of Zhengzhou City,Chengdong Road Community Health Service Center of Zhengzhou City,and Shilihe Town Health Center of Zhengzhou City.They were randomly divided into intervention group(n = 105)and control group(n = 105).Participants in the intervention group received a network-based self-management plan centered on self-efficacy theory,while participants in the control group received routine health education.Observation indexes include blood lipid,glycosylated hemoglobin,waist circumference,systolic blood pressure,lifelong risk of cardiovascular and cerebrovascular diseases,self-efficacy,anxiety and depression.Use smart phone cardiovascular and cerebrovascular risk assessment APP to evaluate the lifelong risk of cardiovascular and cerebrovascular diseases,use health behavior self-efficacy scale to evaluate self-efficacy,and use Hamilton Depression Scale and SAS Anxiety Scale to evaluate anxiety and depression.The total intervention time was 6 months.After the intervention,the data of intervention group and control group were statistically analyzed by SPSS26.0 software.Counting data are expressed by examples and percentages,and chi-square test and Fisher exact probability test are used.The measurement data are expressed by the mean standard deviation,which conforms to the normal distribution,and the variance is uniform,using t test,and the variance is uneven using approximate t test;The measurement data that do not conform to the normal distribution are statistically described by median(M)and interquartile interval(P25,P75),and Mann-Whitney U test is used for comparison.Repeated measurement data were analyzed by repeated measurement variance.P < 0.05 is statistically significant.Results1.Two participants in the intervention group lost their follow-up,and four participants in the control group lost their follow-up.In the end,103 participants in the intervention group and 101 participants in the control group completed the study,with a total of 204 participants completing the study.2.Comparison of data before intervention: There was no significant difference between the intervention group and the control group in clinical characteristics such as age,sex,education level,hypertension,diabetes and family history of cardiovascular and cerebrovascular diseases(P > 0.05).3.Comparison of cardiovascular risk factors and lifetime risk control level of cardiovascular and cerebrovascular diseases: Intra-group comparison: After 6 months of intervention,TC,TG,LDL-C,glycosylated hemoglobin,systolic blood pressure and lifetime risk of cardiovascular and cerebrovascular diseases in the intervention group were lower than those in the control group,and the differences were statistically significant(P<0.05).Comparison between groups: TC,LDL-C,glycosylated hemoglobin,systolic blood pressure and lifetime risk of cardiovascular and cerebrovascular diseases in the two groups were lower than those before the intervention,and the difference was statistically significant(P < 0.05).4.Comparison of anxiety and depression scores: There was no significant difference in anxiety and depression scores between the control group and the intervention group before intervention(P > 0.05).After3 months of intervention,the scores of participants in the intervention group were lower than those in the control group,with statistical significance(P < 0.05).After 6 months of intervention,the scores of anxiety and depression scale in the intervention group were lower than those in the control group,and the difference was statistically significant(P<0.05).Analysis of variance of repeated measurement showed that there was interaction between time effect and intervention effect(P<0.05).5.Comparison of self-efficacy scale scores: There was no significant difference in self-efficacy scale scores between the control group and the intervention group before intervention(P > 0.05).The self-efficacy scores of participants in the intervention group were higher than those in the control group after 3 months of intervention and 6 months after intervention,with statistical significance(P<0.05).Analysis of variance of repeated measurement showed that there was interaction between time effect and intervention effect(P<0.05).ConclusionsNetwork-based self-management plan centered on self-efficacy theory can improve the self-efficacy of young and middle-aged high-risk patients with ASCVD,improve the control level of some cardiovascular risk factors,and reduce the lifelong risk of cardiovascular and cerebrovascular diseases and anxiety and depression.