| Background:According to the statistics,64.3 million people suffer from heart failure.Surgical and drug treatment options for patients with chronic heart failure have improved greatly,but mortality and readmission rates remain high.Self-management is the ability of the patient,with the assistance of health professionals,to take on the main preventive and curative care tasks and to manage the symptoms,treatment,psychology,physiology and lifestyle changes of his/her illness.Self-management is very important for patients with heart failure.Good self-management ability can effectively reduce the rate of re-hospitalization and mortality,improve heart function and improve quality of life.Although a number of guidelines have proposed recommendations on self-management of heart failure,they are comprehensive guidelines,scattered distribution,and the content is not focused enough,which is not conducive to clinical medical staff to make scientific decisions.At the same time,a number of studies have proved that rehabilitation and treatment methods with TCM characteristics can effectively improve patients’ heart function and TCM syndromes and improve their quality of life,and are simple,effective,safe and worthy of clinical promotion and application.Therefore,literature on TCM and western self-management intervention related to this study was obtained by searching major clinical guide websites and Chinese and foreign databases such as PubMed,Web of Science,EMBASE,Wanfang and CNKI.com,and relevant contents were extracted.In addition,a preliminary self-management plan for patients with chronic heart failure was obtained through the discussion of the research team.Based on the preliminary plan obtained in the early stage of this study,a self-management plan suitable for patients with chronic heart failure was established through the Delphi expert correspondence method,providing a reference for the clinical management of patients with chronic heart failure.Objective:Based on traditional Chinese medicine ideas and evidence-based medicine evidence,relevant evidence of self-management of patients with chronic heart failure was retrieved,evaluated and integrated,and the best evidence was summarized to build a chronic heart failure self-management program including diet guidance,exercise guidance,lifestyle guidance,traditional health care and other contents,so as to provide comprehensive guidance for clinical use.Methods:1.Randomized controlled studies related to self-management interventions were searched in PubMed,Embase,Cochrane Library,CINAHL and other English databases,with a search period from January 2000 to December 2022.The retrieved literatures were screened,data extracted and quality evaluated.A network meta-analysis was performed on the included literatures to compare the effects of different self-management interventions on the prognosis of patients with heart failure.2.Search for guidelines,consensus and clinical decisions related to self-management intervention from Wanfang,CNKI,VIP,CBM,PubMed,Embase,Cochrane Library and other Chinese and foreign databases,as well as major guideline websites at home and abroad such as NICE,SIGN and Yimaitong.At the same time,systematic reviews and original studies related to TCM were searched in the above database,various literatures were screened,data extraction and quality evaluation were carried out,and the extracted evidence was integrated to initially construct a self-management plan for patients with chronic heart failure.3.Delphi expert letter consultation method was adopted to select experts to evaluate the preliminary scheme.There were two rounds of Delphi survey.After each round,members of the research team collected and summarized expert opinions and suggestions,revised and improved the scheme,and finally established a complete self-management scheme for patients with chronic heart failure.Results:1.In the mesh meta-analysis,a total of 54 randomized controlled trials were included,including 17,189 participants.The results showed that specific self-management interventions could improve patients’ quality of life and reduce the rate of all-cause hospitalization and heart failure-related hospitalization.Multidisciplinary case management can better reduce all-cause mortality and heart failure-related mortality.2.A total of 49 literatures including evidence-based guidelines,systematic reviews and original studies were finally included in the program construction,including 7 evidence-based guidelines,35 original studies,3 systematic reviews,3 expert consensus and 1 clinical decision.The self-management scheme for patients with chronic heart failure included 9 items of primary level and 40 items of secondary level.3.In the two rounds of Delphi survey,the enthusiasm of experts was high,the coefficient of variation(CV)of the first round was 0.088～0.225,and the coefficient of variation(CV)of the second round was 0.075～0.201.Coefficient of variation(CV)and Kendall coordination coefficient(W)were calculated to show the degree of coordination of expert opinions.The Kendall coefficient(W)of the first round was 0.178(P<0.05),and the Kendall coefficient(W)of the second round was 0.103(P<0.05),which showed that the degree of coordination of expert opinions was high.After two rounds of Delphi investigation,the scheme finally established includes 9 first-level items and 36 second-level items.Conclusion:1.Self-management of patients with heart failure can bring great benefits in reducing hospitalization rate and mortality rate and improving quality of life.More attention and support should be paid to self-management in future diagnosis and treatment of patients with heart failure.2.The construction of self-management program for patients with chronic heart failure provides valuable reference and guidance for future research and clinical use,and it provides effective means and methods for the rehabilitation and improvement of life quality of patients with chronic heart failure.At the same time,it also provides support for the application of traditional Chinese medicine in the management of heart failure,and lays a foundation for further exploration and application. |
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