Research Article: Effects of transitional health management on adherence and prognosis in elderly patients with acute myocardial infarction in percutaneous coronary intervention: A cluster randomized controlled trial

Date Published: May 31, 2019

Publisher: Public Library of Science

Author(s): Qing Wu, Dandan Zhang, Qi Zhao, Lin Liu, Zhisong He, Yan Chen, Hui Huang, Yunyin Hou, Xiaofang Yang, Jie Gu, Antonio Palazón-Bru.

http://doi.org/10.1371/journal.pone.0217535

Abstract

This study aimed to assess the effects of transitional health management on adherence and prognosis in elderly patients with acute myocardial infarction undergoing percutaneous coronary intervention.

We conducted the trial from June 2016 to December 2016. A total of one hundred and fifty patients with acute myocardial infarction after PCI who met the inclusion criteria were randomly divided into an experimental (n = 75) group and a control (n = 75) group. The participants in the experimental group received transitional health management for three months. The two groups of patients were evaluated for treatment adherence, quality of life, clinical indicators, adverse cardiovascular events and statistics regarding readmission rates at baseline and 6 months after discharge.

Compared with the controls, patients in the intervention group demonstrated better medication adherence, reexamination adherence, healthy lifestyle and clinical indicators (all P<0.05) and lower rates of adverse cardiovascular events and readmission (all P<0.05). Transitional health management effectively improved adherence in elderly patients with acute myocardial infarction after PCI, ameliorated clinical indicators, and effectively reduced the incidence of adverse cardiovascular events and readmission rates. Transitional health management was an effective intervention for PCI patients after discharge.

Partial Text

Cardiovascular diseases are the leading cause of death globally[1]. Approximately 17 million people die of cardiovascular disease each year, and 80% of deaths occur in less developed countries[2]. It is expected that by 2020, the danger of cardiovascular disease will rise to first place and will become one of the most important public health problems in China[3]. Coronary heart disease is the most common type of cardiovascular disease, accounting for 67.1% of the death rate[4]. The average cost of hospitalization also tops all medical diseases. At present, there are approximately 290 million patients with cardiovascular diseases in China, including 2.5 million patients with myocardial infarction which known as a heart attack and occurring when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle [5]. In recent years, our country’s acute myocardial infarction (AMI) death rates have steadily increased. From 2002 to 2015, the mortality rate from coronary heart disease in China increased by nearly three-fold[5].

The results of this study showed that patients in the intervention group were treated with medications through a three-month transitional health management program for elderly patients with acute myocardial infarction that included the issuance and interpretation of management manuals, one-on-one assessments, education, supervision, and implementation. The review and healthy lifestyle compliance rates were significantly higher in the intervention group than in the control group (Table 2). There was no significant difference in exercise compliance between the control and the intervention groups (Table 2). This could be because the average age of the study population was more than 65 years old (Table 1), and the subjects may have been worried that getting an exercise-induced injury or increasing the amount of exercise would increase the heart load[29].

The transitional health management intervention, including 12 weeks follow-up, succeeded in elderly patients with AMI undergoing PCI, a period when the majority of patients experience the transition period from hospital to family for rehabilitation. The results demonstrated an improved outcome of participants assigned to a health management intervention group. The intervention provided comprehensive and systematical guide for elderly patients and helped patients adopt active and positive coping styles gradually in the transition period. It ameliorated patient compliance and quality of life, restored the stability of clinical indicators. The ultimate effect of intervention is to help patients make a successful transition to health.

 

Source:

http://doi.org/10.1371/journal.pone.0217535

 

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