| Background: Heart failure patients with preserved ejection fraction accounts for more than half of chronic heart failure patients,and there is no definitive treatment to improve the status in the current condition.As a new diagnosis and treatment mode,telemedicine has been recognized in the diagnosis and treatment of chronic noncommunicable diseases,and it is expected to play its clinical value in the prevention and treatment of heart failure patients with preserved ejection fraction.Objective: The purpose of this study was to investigate the effects of telemedicine model on the management feasibility and efficacy of heart failure patients with preserved ejection fraction.Methods: Two hundred patients of heart failure patients with preserved ejection fraction who were analyzed from August 2017 to July 2018 in Northern Jiangsu People's Hospital.These patients were divided into telemedicine group and control group by randomized control method.The telemedicine group: At the end of 3,6,9 and 12 months after the study,the patients regularly went to the outpatient clinic and got standardized treatment.During the months of 1,2,4,5,7,8,10,11,the medical staff,in every Wednesday afternoon,had video and voice calls with the patients and their family through chronic heart failure management system and related phone APP,to ensure that every patient have a video call once a month at least.At the same time,to achieve comprehensive management of patients,medical staffs according to the patient's symptoms,signs and recent auxiliary examination results to adjust reasonable diet,keep moderate exercise and maintain emotional stability and so on.If it necessary,patients can be treated in outpatient department or in hospital.The control group: Without remote intervention,patients regularly visit to the outpatient department of cardiology of our hospital every 3 months,to get standardized treatment intervention for patients with CHF.Patients can go to the outpatient department or emergency department at any time considering their own disease.During the follow-up,the outpatient visit rate was counted of the two groups of patients.The completion degree of video follow-up in the telemedicine group,the frequency of APP use and satisfaction of the patients,which were investigated,and the participation of family members was counted.At the same time,the two groups of patients of follow-up related data were recorded.We record the data of all patients,including the Morisky,9-EHFSc BS scale,N-terminal pro-brain natriuretic peptide,6 minutes walk test distance,cardiology relevant indicators of cardiac function,classification of New York Heart Association and so on,to analyze the application value of telemedicine for heart failure patients with preserved ejection fraction.After 12 months,the number of people who reached the end of the trial,that is,the first hospitalization for heart failure,was counted.Results: After one year of follow-up,97 patients in the telemedicine group and 93 patients in the control group completed the clinical study.Three patients were lost in the telemedicine group during the follow-up,The control group lost 7 patients.In the follow-up process,the video follow-up number of the telemedicine group was actually completed 671 times(86.47%),and the number of patients whose follow-up number was ?6 times accounted for 84.54%.The outpatient follow-up number of the telemedicine group was actually completed 345 times(88.92%),and that of the control group was 74.19%.In the telemedicine group,88.66% of the patients said that they logged into the patient terminal APP at least once a month,38.14% of the patients said they were very satisfied with the use of the mobile APP,48.45% of the patients said they were satisfied,61.85% of the patients were accompanied by their family members,and 46.39% of the family members of the patients said they were very supportive and willing to participate in the study.Before the follow-up,there were no statistically significant differences between the telemedicine group and the control group in the Morisky scale,9-EHFSc BS scale,N-terminal pro-brain natriuretic peptide,6-minute walking distance,echocardiography related indicators,and cardiac function classification of the New York heart association(P > 0.05).After follow-up,the Morisky scale [6.00(5.13,7.00)vs5.00(4.00,6.00),P < 0.001] and the 9-EHFSc BS scale[30.00(28.00,33.00)vs 27.00(25.00,30.00),P < 0.001] were significantly higher in the telemedicine group than in the control group.NT-pro BNP [994.00(824.50,1279.00)vs1089.00(1024.00,1514.50)P < 0.001] was significantly lower than the control group.The 6-minute walking distance(376.27±59.66 vs 344.59±57.66,P < 0.001)increased compared with the control group.There was no difference in LAD(42.48±8.14vs43.80±5.69,P > 0.05),LVEDD(49.11±5.79vs50.76±6.05,P > 0.05),and LVEF(57.43±3.75vs57.03±3.48,P > 0.05).In the telemedicine group,the number of patients with cardiac function grade III decreased by 5(5.15%),the number of patients with cardiac function grade IV decreased by 1(1.03%),the number of patients with cardiac function grade III increased by 2(2.15%),and the number of patients with cardiac function grade IV decreased by 1(1.08%).At the end of the follow-up,20.42%of the control group and 10.31% of the telemedicine group reached the end point of the follow-up,that is,the first admission for heart failure,and the difference was statistically significant by log-rank test(P < 0.05).Conclusion: Telemedicine has important application value for HFp EF,and its follow-up management program is feasible: it can mobilize the participation of family members,improve the patient follow-up compliance,Increase medication compliance and self-management ability;Improve the quality of life of patients,which is worthy of clinical application and promotion. |
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