PDF(Pubmed)
Abstract：
BACKGROUND: Being the most common type of arrhythmia, atrial fibrillation (AF) is progressively increasing with an annual rate of 5 million new cases. Recent guidelines highlight the importance of using collaborative multidisciplinary teams in order to improve outcomes during management of patients with AF. A nurse-led program including a nurse-directed education, counselling and intervention has shown to improve patients\' outcomes in candidates with AF. In this analysis, we aimed to systematically compare the clinical outcomes observed in patients with AF who were assigned to a nurse-led interventional program versus a usual care group.
METHODS: EMBASE, MEDLINE, Http://www.
RESULTS: gov , Web of Science; Google Scholar and Cochrane databases were the data sources. The clinical outcomes were considered as the endpoints in this study. This is a meta-analysis, and the statistical analysis was conducted by the RevMan software (version 5.4). Risk ratios (RR) with 95% confidence intervals (CI) were used to represent the data after statistical analysis.
RESULTS: Six studies with a total number 2916 participants were included whereby 1434 participants were assigned to a nurse-led intervention and 1482 participants were assigned to the usual care group. Our results showed that participants with AF who were assigned to the nurse-led interventional group had a significantly lower risk of composite endpoints (RR: 0.82, 95% CI: 0.70-0.96; P = 0.01), heart failure (RR: 0.66, 95% CI: 0.47-0.92; P = 0.02), atrial fibrillation (RR: 0.77, 95% CI: 0.63-0.94; P = 0.01) and re-admission (RR: 0.78, 95% CI: 0.62-0.99; P = 0.04). However, the risks of all-cause mortality (RR: 0.86, 95% CI: 0.68-1.09; P = 0.21), cardiac death (RR: 0.67, 95% CI: 0.33-1.39; P = 0.28), myocardial infarction (RR: 0.70, 95% CI: 0.35-1.42; P = 0.33), stroke (RR: 0.75, 95% CI: 0.44-1.26; P = 0.28), all bleeding events (RR: 1.11, 95% CI: 0.81-1.53; P = 0.51) and major bleeding events (RR: 0.91, 95% CI: 0.56-1.49; P = 0.71) were not significantly different.
CONCLUSIONS: The nurse-led interventional program significantly improved composite endpoints including heart failure and the recurrence of AF, resulting in a significantly lower admission rate compared to the usual care group. However, nurse-led interventional program did not affect mortality, stroke, myocardial infarction and bleeding events. Based on our current results, a nurse-led interventional programs apparently could be beneficial in patients with AF. Future larger trials would be able to confirm this hypothesis.
METHODS: EMBASE, MEDLINE, Http://www.
RESULTS: gov , Web of Science; Google Scholar and Cochrane databases were the data sources. The clinical outcomes were considered as the endpoints in this study. This is a meta-analysis, and the statistical analysis was conducted by the RevMan software (version 5.4). Risk ratios (RR) with 95% confidence intervals (CI) were used to represent the data after statistical analysis.
RESULTS: Six studies with a total number 2916 participants were included whereby 1434 participants were assigned to a nurse-led intervention and 1482 participants were assigned to the usual care group. Our results showed that participants with AF who were assigned to the nurse-led interventional group had a significantly lower risk of composite endpoints (RR: 0.82, 95% CI: 0.70-0.96; P = 0.01), heart failure (RR: 0.66, 95% CI: 0.47-0.92; P = 0.02), atrial fibrillation (RR: 0.77, 95% CI: 0.63-0.94; P = 0.01) and re-admission (RR: 0.78, 95% CI: 0.62-0.99; P = 0.04). However, the risks of all-cause mortality (RR: 0.86, 95% CI: 0.68-1.09; P = 0.21), cardiac death (RR: 0.67, 95% CI: 0.33-1.39; P = 0.28), myocardial infarction (RR: 0.70, 95% CI: 0.35-1.42; P = 0.33), stroke (RR: 0.75, 95% CI: 0.44-1.26; P = 0.28), all bleeding events (RR: 1.11, 95% CI: 0.81-1.53; P = 0.51) and major bleeding events (RR: 0.91, 95% CI: 0.56-1.49; P = 0.71) were not significantly different.
CONCLUSIONS: The nurse-led interventional program significantly improved composite endpoints including heart failure and the recurrence of AF, resulting in a significantly lower admission rate compared to the usual care group. However, nurse-led interventional program did not affect mortality, stroke, myocardial infarction and bleeding events. Based on our current results, a nurse-led interventional programs apparently could be beneficial in patients with AF. Future larger trials would be able to confirm this hypothesis.
摘要：
背景：作为最常见的心律失常类型，心房颤动（AF）正在逐步增加，每年有500万例新病例。最近的指南强调了使用多学科协作团队的重要性，以改善房颤患者管理期间的结果。以护士为主导的计划，包括以护士为主导的教育，咨询和干预已显示可改善房颤患者的预后.在这个分析中,我们旨在系统地比较被分配到护士主导的介入治疗方案和常规治疗组的房颤患者的临床结局.
方法：EMBASE，MEDLINE,http：//www。
结果：政府，WebofScience；GoogleScholar和Cochrane数据库是数据源。临床结果被认为是本研究的终点。这是一个荟萃分析，采用RevMan软件（5.4版）进行统计分析。使用风险比（RR）和95％置信区间（CI）表示统计分析后的数据。
结果：共纳入6项研究，共2916名参与者，其中1434名参与者被分配到护士主导的干预，1482名参与者被分配到常规护理组。我们的结果表明，被分配到护士主导的介入组的房颤参与者的复合终点风险显着降低（RR：0.82，95％CI：0.70-0.96；P=0.01），心力衰竭（RR：0.66，95%CI：0.47-0.92；P=0.02），房颤(RR:0.77,95%CI:0.63-0.94;P=0.01)和再入院(RR:0.78,95%CI:0.62-0.99;P=0.04)。然而,全因死亡风险(RR:0.86,95%CI:0.68-1.09;P=0.21),心源性死亡（RR：0.67，95%CI：0.33-1.39；P=0.28），心肌梗死（RR：0.70，95%CI：0.35-1.42；P=0.33），卒中（RR：0.75，95%CI：0.44-1.26；P=0.28），所有出血事件(RR:1.11,95%CI:0.81-1.53;P=0.51)和大出血事件(RR:0.91,95%CI:0.56-1.49;P=0.71)无显著差异.
结论：护士主导的介入方案显著改善了复合终点，包括心力衰竭和房颤复发，导致与常规护理组相比，入院率显着降低。然而,护士主导的介入计划不影响死亡率，中风,心肌梗死和出血事件。根据我们目前的结果,护士主导的介入治疗方案显然对房颤患者有益.未来更大的试验将能够证实这一假设。
方法：EMBASE，MEDLINE,http：//www。
结果：政府，WebofScience；GoogleScholar和Cochrane数据库是数据源。临床结果被认为是本研究的终点。这是一个荟萃分析，采用RevMan软件（5.4版）进行统计分析。使用风险比（RR）和95％置信区间（CI）表示统计分析后的数据。
结果：共纳入6项研究，共2916名参与者，其中1434名参与者被分配到护士主导的干预，1482名参与者被分配到常规护理组。我们的结果表明，被分配到护士主导的介入组的房颤参与者的复合终点风险显着降低（RR：0.82，95％CI：0.70-0.96；P=0.01），心力衰竭（RR：0.66，95%CI：0.47-0.92；P=0.02），房颤(RR:0.77,95%CI:0.63-0.94;P=0.01)和再入院(RR:0.78,95%CI:0.62-0.99;P=0.04)。然而,全因死亡风险(RR:0.86,95%CI:0.68-1.09;P=0.21),心源性死亡（RR：0.67，95%CI：0.33-1.39；P=0.28），心肌梗死（RR：0.70，95%CI：0.35-1.42；P=0.33），卒中（RR：0.75，95%CI：0.44-1.26；P=0.28），所有出血事件(RR:1.11,95%CI:0.81-1.53;P=0.51)和大出血事件(RR:0.91,95%CI:0.56-1.49;P=0.71)无显著差异.
结论：护士主导的介入方案显著改善了复合终点，包括心力衰竭和房颤复发，导致与常规护理组相比，入院率显着降低。然而,护士主导的介入计划不影响死亡率，中风,心肌梗死和出血事件。根据我们目前的结果,护士主导的介入治疗方案显然对房颤患者有益.未来更大的试验将能够证实这一假设。
