Abstract：
Nurse-led case management (CM) may improve quality of life (QoL) for advanced heart failure (HF) patients. No systematic review (SR), however, has summarized its effectiveness/cost-effectiveness. We aimed to evaluate the effect of such programs in primary care settings in advanced HF patients. We examined and summarized evidence on QoL, mortality, hospitalization, self-care, and cost-effectiveness.
The MEDLINE, CINAHL, Embase, Clinical Trials, WHO, Registry of International Clinical Trials, and Central Cochrane were searched up to March 2022. The Consensus Health Economic Criteria instrument to assess risk-of-bias in economic evaluations, Cochrane risk-of-bias 2 for clinical trials, and an adaptation of Robins-I for quasi-experimental and cohort studies were employed. Results from nurse-led CM programs did not reduce mortality (RR 0.78, 95% CI 0.53 to 1.15; participants = 1345; studies = 6; I2 = 47%). They decreased HF hospitalizations (HR 0.79, 95% CI 0.68 to 0.91; participants = 1989; studies = 8; I2 = 0%) and all-cause ones (HR 0.73, 95% CI 0.60 to 0.89; participants = 1012; studies = 5; I2 = 36%). QoL improved in medium-term follow-up (SMD 0.18, 95% CI 0.05 to 0.32; participants = 1228; studies = 8; I2 = 28%), and self-care was not statistically significant improved (SMD 0.66, 95% CI -0.84 to 2.17; participants = 450; studies = 3; I2 = 97%). A wide variety of costs ranging from USD 4975 to EUR 27,538 was observed. The intervention was cost-effective at ≤EUR 60,000/QALY.
Nurse-led CM reduces all-cause hospital admissions and HF hospitalizations but not all-cause mortality. QoL improved at medium-term follow-up. Such programs could be cost-effective in high-income countries.
The MEDLINE, CINAHL, Embase, Clinical Trials, WHO, Registry of International Clinical Trials, and Central Cochrane were searched up to March 2022. The Consensus Health Economic Criteria instrument to assess risk-of-bias in economic evaluations, Cochrane risk-of-bias 2 for clinical trials, and an adaptation of Robins-I for quasi-experimental and cohort studies were employed. Results from nurse-led CM programs did not reduce mortality (RR 0.78, 95% CI 0.53 to 1.15; participants = 1345; studies = 6; I2 = 47%). They decreased HF hospitalizations (HR 0.79, 95% CI 0.68 to 0.91; participants = 1989; studies = 8; I2 = 0%) and all-cause ones (HR 0.73, 95% CI 0.60 to 0.89; participants = 1012; studies = 5; I2 = 36%). QoL improved in medium-term follow-up (SMD 0.18, 95% CI 0.05 to 0.32; participants = 1228; studies = 8; I2 = 28%), and self-care was not statistically significant improved (SMD 0.66, 95% CI -0.84 to 2.17; participants = 450; studies = 3; I2 = 97%). A wide variety of costs ranging from USD 4975 to EUR 27,538 was observed. The intervention was cost-effective at ≤EUR 60,000/QALY.
Nurse-led CM reduces all-cause hospital admissions and HF hospitalizations but not all-cause mortality. QoL improved at medium-term follow-up. Such programs could be cost-effective in high-income countries.
摘要：
护士主导的病例管理（CM）可以改善晚期心力衰竭（HF）患者的生活质量（QoL）。没有系统审查(SR)，然而,总结了其有效性/成本效益。我们旨在评估此类计划在晚期HF患者的初级护理环境中的效果。我们检查并总结了QoL的证据，死亡率,住院治疗,自我照顾,和成本效益。
MEDLINE,CINAHL,Embase,临床试验,WHO,国际临床试验注册，和中央Cochrane被搜索到2022年3月。共识健康经济标准工具，用于评估经济评估中的偏差风险，临床试验的Cochrane偏倚风险2，并采用Robins-I进行准实验和队列研究。护士主导的CM项目的结果并没有降低死亡率(RR0.78,95%CI0.53至1.15;参与者=1345;研究=6;I2=47%)。他们降低了HF住院率（HR0.79，95％CI0.68至0.91；参与者=1989；研究=8；I2=0％）和全因住院率（HR0.73，95％CI0.60至0.89；参与者=1012；研究=5；I2=36％）。中期随访中QoL改善（SMD0.18，95％CI0.05至0.32；参与者=1228；研究=8；I2=28％），自我护理无统计学显著改善(SMD0.66,95%CI-0.84~2.17;参与者=450;研究=3;I2=97%).观察到各种费用，从4975美元到27,538欧元不等。干预措施的成本效益为≤60,000欧元/质量。
护士主导的CM降低了全因入院率和HF住院率，但不能降低全因死亡率。中期随访时QoL有所改善。此类方案在高收入国家可能具有成本效益。
MEDLINE,CINAHL,Embase,临床试验,WHO,国际临床试验注册，和中央Cochrane被搜索到2022年3月。共识健康经济标准工具，用于评估经济评估中的偏差风险，临床试验的Cochrane偏倚风险2，并采用Robins-I进行准实验和队列研究。护士主导的CM项目的结果并没有降低死亡率(RR0.78,95%CI0.53至1.15;参与者=1345;研究=6;I2=47%)。他们降低了HF住院率（HR0.79，95％CI0.68至0.91；参与者=1989；研究=8；I2=0％）和全因住院率（HR0.73，95％CI0.60至0.89；参与者=1012；研究=5；I2=36％）。中期随访中QoL改善（SMD0.18，95％CI0.05至0.32；参与者=1228；研究=8；I2=28％），自我护理无统计学显著改善(SMD0.66,95%CI-0.84~2.17;参与者=450;研究=3;I2=97%).观察到各种费用，从4975美元到27,538欧元不等。干预措施的成本效益为≤60,000欧元/质量。
护士主导的CM降低了全因入院率和HF住院率，但不能降低全因死亡率。中期随访时QoL有所改善。此类方案在高收入国家可能具有成本效益。
