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Acute Myocardial Infarction (AMI) is a major disease that endangers people's health China. At present, clinical emphasis is given to "treatment" rather than "prevention", and a large number of AMI patients are hospitalized repeatedly without systematic and standardized health management after acute stage, falling into a vicious circle of "treatment without recovery". Nurse-led case management based on multidisciplinary collaboration is a new mode of disease management. In 1994, the United States took the lead in applying case management to the acute and chronic care system, providing comprehensive care services and promoting comprehensive recovery through multidisciplinary collaboration led by case managers. At present, the case management model of cardiovascular disease in Europe and the United States has been mature, but it is still in the exploratory stage in China. Through the establishment and application of nurse-led AMI case management program based on multidisciplinary collaboration, this study wants to establish a novel, standardized, and easy to popularize AMI whole-course prevention and control mode, providing theoretical and research basis for AMI disease management.
There are few domestic studies on cardiovascular disease case management in China, and the studies mainly aimed at the application of case management in out-of-hospital follow-up management. At present, there has been no reports on nurse-led the multidisciplinary whole course case management of AMI patients from admission to discharge, diagnosis and treatment, rehabilitation and secondary prevention. This study would apply case management to the whole course management of AMI patients from admission to 6 months after discharge. Pharmacists, nutritionists, rehabilitation specialists and psychiatrists coordinated by nurse would take the initiative to conduct individualized assessment and health guidance, and case managers would participate in the whole process of inpatient diagnosis and treatment. Coordinating multidisciplinary medical resources to jointly implement diagnosis and treatment and rehabilitation for patients can save medical costs and improve the quality of care.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental | Experimental | Patients in the experimental group will receive full-course case management from a multidisciplinary team from admission to 6 months after discharge |
|
| Control | Active Comparator | Patients in the control group will receive routine inpatient care and post-discharge follow-up management |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Nurse -led case management | Other | This study would apply case management to the whole course management of AMI patients from admission to 6 months after discharge. Pharmacists, nutritionists, rehabilitation specialists and psychiatrists led by nurse would take the initiative to conduct individualized assessment and health guidance, and case managers would participate in the whole process of inpatient diagnosis and treatment. Coordinating multidisciplinary medical resources to jointly implement diagnosis and treatment and rehabilitation for patients can improve the quality of care. |
| Measure | Description | Time Frame |
|---|---|---|
| The 36-item Short Form Health Survey for HRQoL | Health-related quality of life | from baseline to 6 months after discharge |
| Coronary artery disease self-management scale for self-management behaviors | Self-management behaviors | from baseline to 6 months after discharge |
| the numbers of unplanned readmission | Unplanned readmission | Through study completion, within 6 months post discharge |
| the number of deaths from cardiac causes | Deaths from cardiac causes | Through study completion,within 6 months post discharge |
| Measure | Description | Time Frame |
|---|---|---|
| the numbers of no smoking | Smoking | from baseline to 6 months after discharge |
| systolic and diastolic blood pressure (mmHg) | Blood Pressure. |
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Inclusion Criteria:
Exclusion Criteria:
Patients have severe heart, brain, liver, kidney, motor dysfunction.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Jingwen Hu | Xi'an | Shaanxi | 710061 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28917025 | Background | Sunamura M, Ter Hoeve N, Geleijnse ML, Steenaard RV, van den Berg-Emons HJG, Boersma H, van Domburg RT. Cardiac rehabilitation in patients who underwent primary percutaneous coronary intervention for acute myocardial infarction: determinants of programme participation and completion. Neth Heart J. 2017 Nov;25(11):618-628. doi: 10.1007/s12471-017-1039-3. | |
| 25301783 |
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| Routine inpatient care and post-discharge follow-up management | Other | Patients in the control group will receive routine inpatient care and post-discharge follow-up management |
|
| from baseline to 6 months after discharge |
| Glycated hemoglobin A1c (%) | Collect fasting venous blood to measure glycosylated hemoglobin A1c | from baseline to 6 months after discharge |
| Body mass index (BMI),kg/m2 | Measure weight and height,then weight and height will be combined to report BMI in kg/m^2 | from baseline to 6 months after discharge |
| Low-density lipoprotein (mmol/L) | Collect fasting venous blood to measure low-density lipoprotein | from baseline to 6 months after discharge |
| Exercise time every week (min) | Inquire the exercise time per week | from baseline to 6 months after discharge |
| Pocock S, Bueno H, Licour M, Medina J, Zhang L, Annemans L, Danchin N, Huo Y, Van de Werf F. Predictors of one-year mortality at hospital discharge after acute coronary syndromes: A new risk score from the EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients) study. Eur Heart J Acute Cardiovasc Care. 2015 Dec;4(6):509-17. doi: 10.1177/2048872614554198. Epub 2014 Oct 9. |
| 31126738 | Background | Puymirat E, Bonaca M, Iliou MC, Tea V, Ducrocq G, Douard H, Labrunee M, Plastaras P, Chevallereau P, Taldir G, Bataille V, Ferrieres J, Schiele F, Simon T, Danchin N; FAST-MI investigators. Outcome associated with prescription of cardiac rehabilitation according to predicted risk after acute myocardial infarction: Insights from the FAST-MI registries. Arch Cardiovasc Dis. 2019 Aug-Sep;112(8-9):459-468. doi: 10.1016/j.acvd.2019.04.002. Epub 2019 May 22. |
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| 8147544 | Background | DeBusk RF, Miller NH, Superko HR, Dennis CA, Thomas RJ, Lew HT, Berger WE 3rd, Heller RS, Rompf J, Gee D, Kraemer HC, Bandura A, Ghandour G, Clark M, Shah RV, Fisher L, Taylor CB. A case-management system for coronary risk factor modification after acute myocardial infarction. Ann Intern Med. 1994 May 1;120(9):721-9. doi: 10.7326/0003-4819-120-9-199405010-00001. |
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| 17718658 | Background | Stafford RS, Berra K. Critical factors in case management: practical lessons from a cardiac case management program. Dis Manag. 2007 Aug;10(4):197-207. doi: 10.1089/dis.2007.103624. |
| 24715403 | Background | O'Neill JL, Cunningham TL, Wiitala WL, Bartley EP. Collaborative hypertension case management by registered nurses and clinical pharmacy specialists within the Patient Aligned Care Teams (PACT) model. J Gen Intern Med. 2014 Jul;29 Suppl 2(Suppl 2):S675-81. doi: 10.1007/s11606-014-2774-4. |
| 23315222 | Background | Huntley AL, Thomas R, Mann M, Huws D, Elwyn G, Paranjothy S, Purdy S. Is case management effective in reducing the risk of unplanned hospital admissions for older people? A systematic review and meta-analysis. Fam Pract. 2013 Jun;30(3):266-75. doi: 10.1093/fampra/cms081. Epub 2013 Jan 12. |
| 28557879 | Background | Ensign CM, Hawkins SY. Improving Patient Self-Care and Reducing Readmissions Through an Outpatient Heart Failure Case Management Program. Prof Case Manag. 2017 Jul/Aug;22(4):190-196. doi: 10.1097/NCM.0000000000000232. No abstract available. |
| 16926693 | Background | Tosun N, Akbayrak N. Global case management: using the case management model for the care of patients with acute myocardial infarction in a military hospital in Turkey. Lippincotts Case Manag. 2006 Jul-Aug;11(4):207-15. doi: 10.1097/00129234-200607000-00004. |
| 23725552 | Background | Chen YC, Chang YJ, Tsou YC, Chen MC, Pai YC. Effectiveness of nurse case management compared with usual care in cancer patients at a single medical center in Taiwan: a quasi-experimental study. BMC Health Serv Res. 2013 May 31;13:202. doi: 10.1186/1472-6963-13-202. |