| 1.Objective:1.1.Cross sectional study:To compare the compliance differences of patients with acute coronary syndrome after PCI in urban and rural areas,and to analyze the reasons for the differences.1.2.Clinical trials:To explore the effect of out of hospital comprehensive management mode on the dependence,improvement of living habits,control of cardiovascular risk factors and major adverse cardiovascular events(MACE)of patients after PCI in rural areas.2.Methods:2.1.Cross sectional study:Questionnaire survey and semi-structured interview were used.Methods from January 1,2019 to June 30,2019,patients with acute coronary syndrome(ACS)in our hospital and underwent PCI for the first time were investigated.A total of 230 questionnaires were distributed and 217 valid questionnaires were collected.Semi structured interview method was used to supplement the contents that could not be scored.Chi square test and nonparametric rank sum test were used to analyze the differences between different data,and logistic regression analysis was used to analyze the related risk factors.2.2.Clinical trials:A total of 164 rural patients who underwent percutaneous coronary intervention(PCI)in our hospital from March 2020 to September 2020 were randomly divided into control group and intervention group according to the random number table.The patients in the control group were given health education,medication plan and dietary guidance during hospitalization.The patients in the control group were required to return visit in the outpatient department of our hospital in the first,second and third months after discharge,and regular telephone follow-up.During hospitalization,the patients in the intervention group received the same health education as the control group,and formulated medication plan and dietary guidance;before discharge,the patients were taught to use the wechat small program of "patient management",and the patient’s medical record information was jointly established with the local community hospital for a 3-month cardiac rehabilitation The control of cardiovascular disease risk factors,improvement of living habits and occurrence of major adverse cardiovascular events(MACE)in the first,second and third months were recorded.Chi square test was used to compare the follow-up completion,improvement of living habits and major adverse cardiovascular events between the two groups,and two independent sample t test and ranksum test were used to measure the improvement of risk factors.3.Result:3.1.Cross sectional study(1)The compliance score of urban patients after PCI was higher than that of rural patients(2.57 ± 0.73 vs 2.38 ± 0.80,P=0.031).The patients’ compliance was affected by cognitive degree(or=3.593,P=0.012).The cognitive degree of urban residents was higher than that of rural residents(2.83± 0.87 vs 2.55± 0.92,P=0.039).(2)By comparing the differences of gender,age and educational level of patients with different cognitive level,we have ascertained that there were differences in educational level(χ2=9.979,P=0.002).Further study on the correlation between educational level and cognitive level found that there was a correlation between educational level and cognitive level(OR=3.431,P=0.002).(3)Comparing the regular return visit,regular medication and self exercise of urban and rural residents,we came to know that the outpatient return visit of urban patients was better than that of rural patients(81.1%vs 58.8%,P<0.01),and there was no significant difference in regular medication and self exercise between the two groups(regular medication:χ2=0.737,P=1.344;regular self exercise:χ2=0.391,P=0.246).Comparing the different factors affecting outpatient follow-up,it was found that patients in urban areas were mainly lack of time(48%),while patients in rural areas were mainly living far away,and the follow-up remained unchanged(45.7%).3.2.Clinical trials(1)Comparing the gender,age,education level,fasting blood glucose(FPG),glycosylated hemoglobin(GHB),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C)before discharge between the intervention group and the control group There was no significant difference in HDL-C,LDL-C,SBP,DBP,height,weight,BMI,smoking,drug dependence and light diet.(2)In this study,74 people were included in the intervention group,72 of them completed the follow-up,2 of them completed part of the follow-up;90 people were included in the control group,80 of them completed the follow-up,10 of them completed part of the follow-up.The completion rate of the intervention group was significantly higher than that of the control group(97.3%vs 88.9%,χ2=4.234,P<0.05).(3)Three months after discharge,compared with the control group,fasting blood glucose(5.70±0.98 vs 6.65±2.07,t=3.593,P<0.05),glycosylated hemoglobin(5.80±0.66 vs 6.33±0.91,z=-3.676,P<0.05),total cholesterol(3.68±0.48 vs 4.12±0.75,z=-4.223,P<0.05),triglyceride(1.64±0.74 vs 2.10±1.01,t=3.24,P<0.05),LDL-C(2.08±0.46 vs 2.28±0.62,z=-2.523,P=0.012),systolic blood pressure(127.11±9.33 vs 130.78 ± 13.54,z=-2.263,P=0.024)were significantly lower than those in the control group.The level of HDL-C was higher than that of control group(1.07±0.15 vs 1.04±0.54,z=-3.080,P=0.002);There was no significant difference in diastolic blood pressure(75.00±7.79 vs 76.08±8.48,z=-0.227,P=0.820).(4)After the intervention,the improvement of living habits between the two groups was observed.It was found that the drug dependence of the intervention group was significantly higher than that of the control group(98.6%vs 89.5%,x2=4.190,P=0.041),There was no significant difference in smoking(10.8%vs 12.8%,χ2=0.149,P=0.700)and light diet(95.9%vs 94.2%,x2=0.021,P=0.884).(5)During 3 months after discharge,the incidence of major adverse cardiovascular events in the intervention group was significantly lower than that in the control group(6.8%vs 18.9%,χ2=5.146,P=0.023).4.Conclusion:4.1.Cross sectional studyIn patients with acute coronary syndrome after PCI,the compliance of patients in urban areas is higher than that in rural areas.The higher the cognitive level of patients,the higher the compliance.The education level of patients affects their cognitive level,which indirectly affects the compliance of patients.The regular outpatient return visit of rural patients is low,at the same time,it is related to economic reasons,living far away,inconvenient outpatient follow-up and other factors.4.2.Clinical trialsWe have considered "Top three hospitals-rural regional medical and health centers-patients" as the main body,combined with Wechat Mini program(wechat mini)The multi-dimensional management of this app can significantly improve the degree of participation in cardiac rehabilitation of patients after PCI;improve the control level of cardiovascular and cerebrovascular disease risk factors of patients after PCI;improve the medication compliance of patients;reduce the occurrence of recent major cardiovascular events of patients;but it has no obvious help for the improvement of smoking cessation and diet structure of patients. |
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