| Objective:To explore the effect of comprehensive management mode on improving cardiac function and quality of life in elderly patients with heart failure combined with atrial fibrillation.Methods:230 elderly patients with atrial fibrillation combined with heart failure admitted to Shanxi Bethune Hospital from March 1,2018 to September 30,2019,were finally 109 in the management group and 91 in the control group.The management team adopted the comprehensive management mode for management.The control group was routine follow-up for patients.Six months after treatment,the cardiac function level and quality of life before and after treatment were evaluated in the two groups.The end point of the study is visceral bleeding or stroke.The two groups tested the project at the time of discharge and six months after discharge: all the subjects used the NYHA classification method to diagnose cardiac function;the six-minute walking test was measured;the plasma BNP concentration was collected in the early morning venous blood test of the subjects;the color Doppler ultrasound radiography doctor measured the left diastolic end diameter,the left ventricular ejection score,and the average ventricular rate of the 24 h dynamic electrocardiogram;and the quality of life evaluation of patients was evaluated using the Minnesota Quality of life evaluation scale.Curative effect judgment standard:1.Discretion: cardiac function improves level II or above,and symptoms disappear;2.Effective: cardiac function improves level I,and the symptoms are significantly relieved;3.Invalidity: no improvement or aggravation or death of cardiac function,no remission of symptoms.Results:(1)Multi-factor repeated measurement analysis results of the six-minute walk test showed that the interaction between the management group and the control group before and after treatment was statistically significant(F=1.828,P=0.180).Further analysis of the main effect results showed that the difference of six-minute walking between different groups was statistically significant(F=4.152,P=0.045),the average six-minute walk in the management group was 28.77 meters higher than that of the control group(95% CI: 0.719,56.819);the six-minute walking difference before and after treatment was statistically significant(F=67.588,P<0.001),and the six minutes of walking in the six months after treatment was higher than that of 63.29 meters(95% CI: 48.00,78.58).(2)The results of multi-factor repeated measurement of BNP showed that the interaction between the management group and the control group was not statistically significant before and after treatment(F=0.132,P=0.717).The results of further analysis showed that the BNP differences between different groups were statistically significant(F=0.001,P=0.990);the BNP differences before and after treatment were statistically significant(F=27.330,P<0.001),which was 79.45 pg/ml(95%CI: 49.26,109.64)higher than the BNP six months after treatment.(3)The results of multi-factor repeated measurement of ejection score showed that the interaction between the management group and the control group before and after treatment was statistically significant(F=4.556,P=0.35).Further analysis of the results showed that the difference in ejection scores between different groups before treatment was statistically significant(F=.375,P=0.0.005),4.08 percent higher than that of the control group(95%CI:1.28,6.88);the difference in ejection scores between different groups in the six months after treatment was not statistically significant(F=0.213,P=0.645);the difference in the ejection score before and after treatment in the management group was statistically significant(F=21.211,P<0.001),which was 5.193%higher than that of the previous six months of treatment(95%CI:2.96,7.43);the difference in the control group was statistically significant.(4)Multifactorial repeated measurements of the average ventricular rate of patients with 24-hour dynamic electrocardiogram showed that the interaction between the management group and the control group before and after treatment was statistically significant(F=0.837,P=0.363).Further analysis of the main effect results showed that the average ventricular rate difference between different groups with24-hour dynamic electrocardiograms was statistically significant(F=6.929,P=0.010),and the control group was higher than that of the management group was 3.56s(95%CI: 0.87,6.25);there was no statistical difference in the 24-hour dynamic electrocardiogram before and treatment(F=2.504,P=0.117).(5)Multi-factor repeated measurement and analysis results of the left ventricular diastolic end(F=9.259,P=0.003)were statistically significant in the management group and control group before and after treatment(F=9.259,P=0.003).Further analysis of the results showed that the difference in the left ventricular diastolic end diameter between different groups before treatment was statistically significant(F=0.503,P=0.480);the difference in the left ventricular diastolic end diameter between different groups between the different groups in the six months after treatment was statistically significant(F=16.035,P<0.001),3.71 mm higher than the control group than the management group(95% CI: 1.87,5.56);the difference in the left ventricular diastolic end of the management group was statistically significant(F=106.565,P<0.001).(6)Multi-factor repeated measurement analysis of quality of life score shows that there is no statistical significance for the interaction between the management group and the control group before and after treatment(F=1.736,P=0.392).Further analysis of the main effect results shows that the difference in quality of life scores between different groups before treatment is not statistically significant(F=3.164,P=0.750).The difference in quality of life score after treatment is statistically significant(F=18.295,P<0.001).The control group was 11.04 higher than the management group(95% CI: 5.08,17.25).The difference in the quality of life score before and after treatment in the management group is of statistical significance(F=16.795,P<0.001),which is 22.84(95% CI: 16.25,28.59)higher than after treatment.The difference in the left ventricular diastolic end diameter before and after treatment in the control group is statistically significant.(F=18.563,P<0.001),11.84 higher than after treatment(95% CI: 7.25,14.66).(7)The distribution of effective and effective patients in the management group was higher than that in the control group,and the difference was statistically significant.Conclusion:Compared with traditional follow-up,the mental function and quality of life of elderly patients with heart failure combined with atrial fibrillation can be improved under comprehensive management mode. |
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