Application research of an mHealth-based symptom clusters management program in the nursing of chronic heart failure patients

doi:10.3761/j.issn.0254-1769.2024.11.002

Abstract

Abstract:

Objective This study aims to investigate the application of symptom group management using a mobile health platform in managing heart failure patients during convalescence. Methods The research involved patients with chronic heart failure who were treated at a tertiary A hospital in Qingdao from June 2022 to December 2022. The experimental group consisted of 235 patients who were discharged after treatment in ward A，while the control group consisted of 235 patients who were discharged during the same period in ward B. The experimental group received an mHealth-based symptom clusters management program following routine continuous nursing and the control group was given routine continuous nursing after discharge. 6 months after the intervention，the heart function status，self-care level，and quality of life were compared between 2 groups. Results The experimental group ultimately included 232 cases，while the control group ultimately included 225 cases. Furthermore，the cardiac functional status，level of self-care，and quality of life of both the experimental group and the control group showed improvement compared to the pre-intervention period（P<0.05）. The experimental group exhibited significantly better cardiac function status compared to the control group，and the experimental group demonstrated higher levels of self-care confidence，and quality of life relative to the control group（P<0.05）. Conclusion The utilization of a mobile medical platform can enhance the management of heart failure patients’ symptom groups，resulting in improved disease management efficiency. This platform provides patients with a comprehensive self-management plan，ultimately enhancing their self-management abilities and overall outcomes.

Key words: Symptom Cluster, Heart Failure, Mobile Health, Continuing Care

摘要：

目的探讨基于移动医疗的症状群管理在慢性心力衰竭（chronic heart failure，CHF）患者延续性护理中的应用效果。方法组建研究团队，基于院内移动医疗平台设计CHF患者症状群管理模块，选取青岛市某三级甲等医院2022年6月—12月心血管内科收治的CHF患者作为研究对象，其中A病区的235例作为试验组，B病区的235例作为对照组。试验组在常规延续护理的基础上实施基于移动医疗的症状群管理，对照组采用常规延续护理。比较两组出院时、出院6个月的心功能状态、自我护理水平和生活质量的差异。结果试验组最终纳入232例，对照组纳入225例。出院6个月后，两组心功能状态、自我护理水平及生活质量均较干预前改善（P<0.05）；出院6个月后，试验组心功能状态、自我护理水平及生活质量均优于对照组（P<0.05）。结论基于移动医疗平台对CHF患者进行症状群管理，能提高疾病管理效率，并为患者提供整体的自我管理计划，提高患者的自我管理能力，改善患者结局。

关键词: 症状群, 心力衰竭, 移动医疗, 延续性护理

ZHAO Menglu, LU Xiaohong, CAO Lihua, LI Fuhai, HAN Jing, JIANG Xin, CUI Weining, ZHAO Qian, ZHANG Wenzhong. Application research of an mHealth-based symptom clusters management program in the nursing of chronic heart failure patients[J]. Chinese Journal of Nursing, 2024, 59(11): 1294-1300.

赵梦璐, 卢晓虹, 曹丽华, 李福海, 韩静, 姜欣, 崔伟宁, 赵倩, 张文忠. 基于移动医疗的症状群管理在慢性心力衰竭患者中的应用研究[J]. 中华护理杂志, 2024, 59(11): 1294-1300.

Figures/Tables 5

Table 1 Comparison of general data between the 2 groups[case（percentage，%）]

Table 2 Comparison of left ventricular ejection fraction and B-type brain natriuretic peptide before and after interventions of 2 groups（$\bar{x}±s$）

Table 3 Comparison of 6MWT between the 2 groups after 6 months of discharge[case（percentage，%）]

Table 4

Table 5

References 21

[1]	中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10):760-789.
	Heart Failure Group of Chinese Society of Cardiology of Chi-nese Medical Association,Chinese Heart Failure Association of Chinese Medical Doctor Association, Editorial Board of Chinese Journal of Cardiology. China guidelines for the diagnosis and treatment of heart failure 2018[J]. Chin J Cardiol, 2018, 46(10):760-789.
[2]	Sethares KA, Chin E. Age and gender differences in physical heart failure symptom clusters[J]. Heart Lung, 2021, 50(6):832-837. DOI PMID
[3]	Correction to:heart disease and stroke statistics-2018 update:a report from the American Heart Association[J]. Circulation, 2018, 137(12):e493.
[4]	杨贝贝, 郑战战, 吴圣佳, 等. 慢性稳定性心力衰竭患者症状群分类的研究[J]. 中国护理管理, 2018, 18(2):185-191.
	Yang BB, Zheng ZZ, Wu SJ, et al. Identification of symptom clusters in patients with chronic stable heart failure[J]. Chin Nurs Manag, 2018, 18(2):185-191.
[5]	宣凡馨, 李峥, 康晓凤, 等. 心力衰竭患者症状群的纵向研究[J]. 中华护理杂志, 2017, 52(12):1450-1456.
	Xuan FX, Li Z, Kang XF, et al. Changes of heart failure symptom clusters during the course of disease:a longitudinal study[J]. Chin J Nurs, 2017, 52(12):1450-1456.
[6]	蔡建平, 田焕, 杨巧芳. 慢性心力衰竭患者症状群特征及其影响因素分析[J]. 中华现代护理杂志, 2021, 27(25):3410-3415.
	Cai JP, Tian H, Yang QF. Characteristics and influencing factors of symptom cluster in patients with chronic heart failure[J]. Chin J Mod Nurs, 2021, 27(25):3410-3415.
[7]	余舒欣, 林荣, 祝雪花. 政策工具视角下国内护理卫生政策的文本分析[J]. 中华护理杂志, 2023, 58(7):843-849. DOI
	Yu SX, Lin R, Zhu XH. Textual analysis of China’s nursing and health policies from the perspective of policy instruments[J]. Chin J Nurs, 2023, 58(7):843-849. DOI
[8]	Maurya MR, Riyaz NUSS, Reddy MSB, et al. A review of smart sensors coupled with Internet of things and artificial intelligence approach for heart failure monitoring[J]. Med Biol Eng Comput, 2021, 59(11/12):2185-2203.
[9]	王志燕, 陈晨, 吕强, 等. 2021年ESC急慢性心力衰竭诊断与治疗指南解读[J]. 中华心血管病杂志, 2021, 49(12):1252-1255. PMID
	Wang ZY, Chen C, Lü Q, et al. Highlights and interpretation of the 2021 European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Chin J Cardiol, 2021, 49(12):1252-1255. DOI PMID
[10]	Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure:executive summary:a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J]. J Am Coll Cardiol, 2022, 79(17):1757-1780. DOI PMID
[11]	ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement:guidelines for the six-minute walk test[J]. Am J Respir Crit Care Med, 2002, 166(1):111-117.
[12]	吕青云, 张晓楠, 江思璇, 等. 中文版明尼苏达心衰生活质量量表的维度分析[J]. 现代预防医学, 2023, 50(7):1267-1272.
	Lü QY, Zhang XN, Jiang SX, et al. Dimensional analysis of the Chinese version of Minnesota Living with Heart Failure Questionnaire[J]. Mod Prev Med, 2023, 50(7):1267-1272.
[13]	郭金玉, 李峥, 康晓凤. 心力衰竭自我护理指数量表的汉化及信效度检测[J]. 中华护理杂志, 2012, 47(7):653-655.
	Guo JY, Li Z, Kang XF. Sinicization and reliability testing of the Heart Failure Self-Care Index Scale[J]. Chin J Nurs, 2012, 47(7):653-655..
[14]	Connolly M, Ryder M. Consideration of symptom management in advanced heart failure[J]. Int J Environ Res Public Health, 2022, 19(22):15160.
[15]	衣艳凤, 袁越, 宋红霞, 等. 心力衰竭患者症状群与生活质量的相关性研究[J]. 护理学报, 2018, 25(1):10-13.
	Yi YF, Yuan Y, Song HX, et al. Relationship between symptom cluster and quality of life in patients with heart failure[J]. J Nurs (China), 2018, 25(1):10-13.
[16]	Wu JR, Lin CY, Hammash M, et al. Heart failure knowledge,symptom perception,and symptom management in patients with heart failure[J]. J Cardiovasc Nurs, 2022, 38(4):312-318.
[17]	Liu SR, Li JL, Qu Z, et al. The effectiveness of eHealth self-management interventions in patients with chronic heart failure:protocol for a systematic review and meta-analysis[J]. PLoS One, 2022, 17(9):e0268446.
[18]	陈瑜, 陆敏敏. 慢性心衰患者移动健康管理范围综述[J]. 中国护理管理, 2022, 22(11):1701-1706.
	Chen Y, Lu MM. Mobile health management among chronic heart failure patients:a scoping review[J]. Chin Nurs Manag, 2022, 22(11):1701-1706.
[19]	Clements L, Frazier SK, Lennie TA, et al. Improvement in heart failure self-care and patient readmissions with caregiver education:a randomized controlled trial[J]. West J Nurs Res, 2023, 45(5):402-415.
[20]	Wiśnicka A, Lomper K, Uchmanowicz I. Self-care and quality of life among men with chronic heart failure[J]. Front Public Health, 2022, 10:942305.
[21]	Cordeiro ALL, da Silva Miranda A, de Almeida HM, et al. Quality of life in patients with heart failure assisted by telerehabilitation:a systematic review and meta-analysis[J]. Int J Telerehabil, 2022, 14(1):e6456. DOI PMID