THE EFFECT OF DISCONTINUOUS REMOTE CARDIOGRAM MONITORING ON CHRONIC HEART FAILURE PATIENTS OUT-OF-HOSPITAL MANAGEMENT
Aim: Evaluation of discontinuous remote Cardiogram monitoring of patients with chronic heart failure management value
Methods: Chronic heart failure is a variety of end-stage heart disease development stage, in recent years, although drug treatment such as ACEI, beta blockers, and aldosterone receptor antagonist and treatments such as ICD, CRT - D applied to clinical, effectively improve the quality of survival and reduces the mortality rate and prolong the patients life, but its mortality is still high, NYHA class - level,mainly died of cardiac arrhythmia sudden death, NYHA class level, mainly died of pump failure. Research has shown that heart failure patients outside management to reduce hospital patients hospitalization rates, improve the survival rate has important significance. Especially for patients with stable chronic heart failure, access to the ECG information regularly, to adjust the treatment plan, play an important role for a shorter visit in the hospital. Stability of chronic heart failure patients with discontinuous remote cardiogram monitoring in the management of chronic heart failure lobbyists function value is not clear, we had discussed it.
Choice in July 2009 - July 2011 in our hospital outpatient clinic of 65 cases of patients with chronic heart failure, followed up for 1 year, cardiac function NYHA classification - level, are not suitable for implanted ICD, CRT - D or disagree with the above equipment, basic heart disease: dilated cardiomyopathy 33 cases, 28 cases of coronary heart disease, rheumatic heart disease surgery four people; Aged 64 2; 24 cases of male, 41 cases were female. All patients were using ACEI, beta blockers, and aldosterone receptor antagonists, such as the ideal drug therapy. Randomly divided into two groups, namely the discontinuous remote ECG monitoring group (observation group) n = 33, n = 32 with control group, both groups in the level of cardiac function, drug treatment and basic heart disease such as baseline sampling no difference.The equipment produce By heavens high-tech medical co, LTD,Lead by compatible digital record comprehensive information transmitter, can be continuously collected patients ECG information of living conditions, monitoring of cardiac electrophysiological changes. Send information using mobile GPRS transmission techniques, monitoring data, the automatic early warning analysis diagnosis, received a doctor of diagnosis of the doctor’s advice; By using modern network technology will be a long time monitoring of ECG information transmitted to the monitoring center, through the dynamic ECG analysis software, check analysis of patients with a variety of symptoms, diagnostic report is given.production type synchronous 12-lead remote monitoring system.1 time a month regular follow-up for all patients, evaluate the quality of life, using the Minnesota living quality evaluation: article eight body areas with five entries, emotional areas and other areas of eight items, a total of 21 items, typical signs and symptoms of heart failure, physical activity, social relationships, activities, emotions, entry USES the level 5, Kurt ikert (1) score, score van Wei 0 ~
10.5 (no function is lost to most people degrees of functional loss). Observation, on the basis of its in regular follow-up intervention, to 1, 72 hours every two weeks at home remote cardiogram monitoring and record 24 hours mean heart rate, all kinds of arrhythmia and ischemia of load change. And according to the monitoring results to guide patients with drug adjustment and lifestyle changes. Judgment indicators: (1) evaluation of the quality of life; 2) the number of acute heart failure hospitalization; 3) deaths
Results: The quality of life scores shown in table 81.1.There is significant difference between the two groups, observation group of the quality of life score has obvious change; 2) The number of acute heart failure hospitalization: 3 Cases in observation group and 14 cases in control group ,there is significant difference between the two groups, acute heart failure hospitalization had less; 3) Deaths: 1 case in observation group and 5 cases in control group ,the death happens to two groups have obvious difference.
Conclusion: Outside the hospital in patients with chronic heart failure management, discontinuous remote cardiogram monitoring evaluation to improve the quality of life, reduce the acute hospitalization, reducing death has important clinical significance.
Table 81.1. Quality of life scale. 1