| Objective By integrating clinical decision support tools,guide-based treatment programs and patient self-participation strategies,a community-family chronic cardiovascular disease telemedicine management model under the guidance of large regional hospitals was constructed to evaluate the feasibility of applying this model to remote management of patients with atrial fibrillation.Sexuality provides evidence support for the development of telecardiology for chronic cardiovascular disease such as atrial fibrillation.Methods Through the integration of clinical decision support tools,guide-based treatment programs and patient self-participation strategies,a community-family chronic cardiovascular disease telemedicine management model under the guidance of regional health hospitals supported by mobile health technology was constructed;Atrial fibrillation patients who were admitted to the Cardiovascular Department of Subei People’s Hospital from July to September 2017 were included in the study.A total of 92 patients were enrolled.The management model was used to complete the 6-month follow-up management.Based on the standard drug and or device therapy,the design was slow.The disease management platform and the corresponding application software were used to follow up the patients,and the medical parameters of the patients were collected.The drug compliance,quality of life,number of symptoms,unexpected visits and anti-coagulation knowledge of atrial fibrillation were compared before and after follow-up.This model is used for the feasibility of telemedicine management in patients with atrial fibrillation.Results (1)A total of 92 patients were enrolled in the study.The follow-up rate was 5.43%,and the average follow-up time was(6.64±0.76)months;(2)In the study,the application rate of the chronic disease management application software was 86.02%,and the follow-up compliance(≥4 times)accounted for 86.21%.The median and monthly income levels of the application software were positively correlated with the number of use(P<0.01),but the age,gender and education level were not related(P>0.05).The overall satisfaction of the follow-up management model was 94.25%;(3)After 6 months of follow-up,the patient’s drug compliance increased from 47.13% to 58.62%(P=0.13).Subgroup analysis according to patient follow-up,suggesting follow-up compliance(≥4 follow-up records)drug compliance increased(P=0.01),and drug compliance was not significantly improved in patients with poor follow-up(P=0.10).The overall quality of life score of patients was improved.Except for RP and RE dimensions,the differences of the other six dimensions were statistically significant(P<0.05).The number of unexpected visits per patient decreased from 1.99 per month to 1.42 per month,and the number of symptom episodes decreased from 3.39 per month to 2.81 per month;(4)The results of the warfarin anticoagulant knowledge questionnaire showed that the patients’ knowledge of anticoagulant increased with the time of follow-up.There were statistically significant differences before and after follow-up in the risk of atrial fibrillation,whether atrial fibrillation requires anticoagulant,anticoagulant effect,warfarin effect,the significance of monitoring INR,the range of INR target,the frequency of INR monitoring and the self-test bleeding site.There was no statistically significant difference in the INR-affecting drugs and foods,and vitamin K-rich foods.Conclusions This study shows that the long-term follow-up model of chronic cardiovascular disease supported by mobile health technology is safe and feasible in the long-term management of chronic cardiovascular diseases such as atrial fibrillation.It can fully exploit the potential of patient self-management,improve patients’ health knowledge,optimize the compliance of atrial fibrillation treatment,and ultimately improve the quality of life,but more powerful clinical evidence is yet to be supported by larger data analysis. |
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