心衰竭急性後期多專科照護之成效

Effect of Post-Acute Multidisciplinary Care in Heart Failure Cases

心衰竭病人因液體容積過量引起呼吸困難、疲倦等症狀，其再住院率與死亡率皆高，本案為北台灣某醫學中心之心衰竭急性後期整合照護計畫（post-acute care program, PAC），期能改善心衰病人照護成效。為探討心衰竭個案接受PAC照護與否之成效差異。此回溯性縱向研究，納入2018年2月2日至2019年12月31日因心衰竭惡化而住院之受試者（n = 305），以其心專醫師具PAC證書為PAC組（n = 187），反之為非急性後期整合照護計畫組（n = 118）。結果顯示PAC組返診率較高（p = 0.014）、急診就醫次數較低（p = 0.011）、再住院發生較晚且全因死亡率較低，年齡越大死亡風險越高（p = 0.049）。PAC組較非PAC組存活平均延長20.2天（p = 0.020）。PAC照護之病人急性醫療需求下降、再住院發生時間較晚、死亡率降低且存活平均天數延長。本研究結果顯見以個管師為窗口且整合多專科團隊共同照護之下，對心衰竭病人具相當成效。

Patients with heart failure who exhibit symptoms of fluid overload, such as dyspnea and fatigue, are associated with a high rate of readmission and mortality. This study examines the impact of a post-acute care program (PAC) initiated by the National Health Insurance Administration at a medical center in northern Taiwan. We hope to improve the outcomes of care for patients with heart failure. To investigate the difference in outcome between the PAC group and the non-post-acute care program (non-PAC) group. This retrospective longitudinal study included 305 subjects admitted for worsening heart failure between February 2, 2018, and December 31, 2019, according to government regulations. Those with PAC certification from their cardiologist were assigned to the PAC group (n=187), while those without were assigned to the non-PAC group (n=118). The rate of outpatient follow-up in the PAC group was higher (p = 0.014), lower frequency of emergency department visits (p = 0.011), later rehospitalization events. In addition, the all-cause mortality rate in the PAC group was lower than non-PAC group. As age increases, the risk of mortality also increases (p = 0.049). The PAC group demonstrated an average extension of survival by 20.2 days compared to the non-PAC group (p = 0.020). Post-acute care for heart failure patients resulted in decreased acute medical needs, delayed rehospitalization events, significantly lower all-cause mortality rates, and longer mean survival days. This study suggests that a multi-disciplinary system-heart failure (MDS -HF) with a case manager as the point of contact can effectively improve care for heart failure patients.