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Continuity of care and its associations with self-reported health, clinical characteristics and follow-up services after percutaneous coronary intervention

经皮冠状动脉介入治疗后护理的连续性及其与自我报告健康、临床特征和随访服务的相关性

  • 影响因子:2.26
  • DOI:10.1186/s12913-020-4908-1
  • 作者列表:"Irene Valaker","Bengt Fridlund","Tore Wentzel-Larsen","Jan Erik Nordrehaug","Svein Rotevatn","Maj-Britt Råholm","Tone M. Norekvål
  • 发表时间:2020-02-02
Abstract

Abstract Aims Complexity of care in patients with coronary artery disease is increasing, due to ageing, improved treatment, and more specialised care. Patients receive care from various healthcare providers in many settings. Still, few studies have evaluated continuity of care across primary and secondary care levels for patients after percutaneous coronary intervention (PCI). This study aimed to determine multifaceted aspects of continuity of care and associations with socio-demographic characteristics, self-reported health, clinical characteristics and follow-up services for patients after PCI. Methods This multi-centre prospective cohort study collected data at baseline and two-month follow-up from medical records, national registries and patient self-reports. Univariable and hierarchical regressions were performed using the Heart Continuity of Care Questionnaire total score as the dependent variable. Results In total, 1695 patients were included at baseline, and 1318 (78%) completed the two-month follow-up. Patients stated not being adequately informed about lifestyle changes, medication and follow-up care. Those experiencing poorer health status after PCI scored significantly worse on continuity of care. Patients with ST-segment elevation myocardial infarction scored significantly better on informational and management continuity than those with other cardiac diagnoses. The regression analyses showed significantly better continuity (P ≤ 0.034) in patients who were male, received written information from hospital, were transferred to another hospital before discharge, received follow-up from their general practitioner or had sufficient consultation time after discharge from hospital. Conclusion Risk factors for sub-optimal continuity were identified. These factors are important to patients, healthcare providers and policy makers. Action should be taken to educate patients, reconcile discharge plans and organise post-discharge services. Designing pathways with an interdisciplinary approach and shared responsibility between healthcare settings is recommended.

摘要

摘要目的: 由于老龄化、治疗改善和更专业的护理,冠心病患者的护理复杂性正在增加。患者在许多环境中接受各种医疗保健提供者的护理。尽管如此,很少有研究评估经皮冠状动脉介入治疗 (PCI) 后患者初级和二级护理水平的护理连续性。本研究旨在确定 PCI 术后患者护理连续性的多方面以及与社会人口学特征、自我报告健康、临床特征和随访服务的相关性。方法这项多中心前瞻性队列研究从病历、国家登记和患者自我报告中收集基线和两个月随访时的数据。以心脏连续性护理问卷总分为因变量进行单变量和分层回归。结果在基线时共纳入 1695 例患者,1318 例 (78%) 完成了两个月的随访。患者表示没有充分了解生活方式的改变、用药和后续护理。PCI 术后健康状况较差的患者在护理连续性方面得分显著更差。ST 段抬高型心肌梗死患者在信息和管理连续性方面的得分显著优于其他心脏诊断患者。回归分析显示,男性患者出院前从医院收到书面信息,转入另一家医院的患者连续性显著较好 (p ≤ 0.034)。接受其全科医生的随访或出院后有足够的咨询时间。结论确定了次优连续性的风险因素。这些因素对患者、医疗保健提供者和政策制定者都很重要。应采取行动教育患者,协调出院计划并组织出院后服务。建议采用跨学科方法设计路径,并在医疗机构之间分担责任。

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影响因子:10.49
发表时间:2020-01-02
DOI:10.1172/JCI124708
作者列表:["Jain M","Dhanesha N","Doddapattar P","Chorawala MR","Nayak MK","Cornelissen A","Guo L","Finn AV","Lentz SR","Chauhan AK"]

METHODS::Fibronectin-splice variant containing extra domain A (Fn-EDA) is associated with smooth muscle cells (SMCs) following vascular injury. The role of SMC-derived Fn-EDA in SMC phenotypic switching or its implication in neointimal hyperplasia remains unclear. Herein, using human coronary artery sections with a bare metal stent, we demonstrate the expression of Fn-EDA in the vicinity of SMC-rich neointima and peri-strut areas. In mice, Fn-EDA colocalizes with SMCs in the neointima of injured carotid arteries and promotes neointima formation in the comorbid condition of hyperlipidemia by potentiating SMC proliferation and migration. No sex-based differences were observed. Mechanistic studies suggested that Fn-EDA mediates integrin- and TLR4-dependent proliferation and migration through activation of FAK/Src and Akt1/mTOR signaling, respectively. Specific deletion of Fn-EDA in SMCs, but not in endothelial cells, reduced intimal hyperplasia and suppressed the SMC synthetic phenotype concomitant with decreased Akt1/mTOR signaling. Targeting Fn-EDA in human aortic SMCs suppressed the synthetic phenotype and downregulated Akt1/mTOR signaling. These results reveal that SMC-derived Fn-EDA potentiates phenotypic switching in human and mouse aortic SMCs and neointimal hyperplasia in the mouse. We suggest that targeting Fn-EDA could be explored as a potential therapeutic strategy to reduce neointimal hyperplasia.

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影响因子:4.65
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DOI:10.1161/ATVBAHA.119.313602
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