[The impact of smart healthcare-based full-cycle healthcare management on patients with mitral regurgitation undergoing TEER]
- PMID: 40825733
- DOI: 10.3760/cma.j.cn112148-20250107-00022
[The impact of smart healthcare-based full-cycle healthcare management on patients with mitral regurgitation undergoing TEER]
Abstract
Objective: To explore the advantages of internet-based smart healthcare for full-cycle transcatheter edge-to-edge repair (TEER) management in reducing postoperative adverse events rate, improving cardiac function, and enhancing quality of life. Methods: This retrospective study enrolled patients with mitral regurgitation who underwent transcatheter TEER at Beijing Anzhen Hospital Valve Intervention Center between June 2021 and September 2023. Patients were classified into degeneration mitral regurgitation (DMR) and functional mitral regurgitation (FMR) according to etiology, with further stratification by enrollment period into usual care group (June 2021 to October 2022) and full-cycle management group (November 2022 to September 2023). The 1-year postoperative follow-up data were collected and compared between subgroups with the same etiology. Kaplan-Meier survival curves were plotted, and log-rank tests were used to compare the differences in major endpoint event-free survival rates between the two groups. Univariate and multivariate Cox regression and logistic regression analyses were performed to evaluate the impact of the full-cycle management system on patients' outcomes. Results: A total of 130 patients were included, aged (72.0±8.6) years, including 82 (63%) males. DMR was identified in 84 cases (40 in the usual care group and 44 in the full-cycle management group), while FMR was observed in 46 cases (27 in the usual care group and 19 in the full-cycle management group). Kaplan-Meier analysis demonstrated higher 1-year major endpoint event-free survival rates in the full-cycle management group compared to the usual care group, though the difference was not statistically significant (log-rank P>0.05). Compared to the usual care group, the full-cycle management group showed significantly higher proportions of New York Heart Association classification Ⅰ-Ⅱ patients (DMR: 67% vs. 52%, P=0.031; FMR: 68% vs. 52%, P=0.021), greater 6-minute walking distances (DMR: (346.39±70.41) m vs. (294.11±60.47) m, P=0.012; FMR: (356.60±54.68) m vs. (318.55±39.02) m, P=0.004), and superior Kansas City Cardiomyopathy Questionnaire scores (DMR: 81.50 (74.50, 85.00) points vs. 71.00 (66.00, 82.25) points, P=0.014; FMR: 83.00 (76.00, 85.00) points vs. 74.00 (70.75, 80.00) points, P=0.030). Multivariate logistic regression confirmed the full-cycle management system as an independent predictor for the above improved outcomes (all P<0.05). Conclusion: Smart healthcare-based full-cycle management improves cardiac function and quality of life in mitral regurgitation patients after TEER, demonstrating lower rates of major endpoint events compared to usual care.
目的： 探讨基于互联网智慧医疗的经导管二尖瓣缘对缘修复术（TEER）全流程管理体系在降低患者术后不良事件发生率、改善心功能和提升生活质量方面的优势。 方法： 本研究为回顾性研究。纳入2021年6月—2023年9月于北京安贞医院心脏瓣膜病介入中心接受TEER的二尖瓣反流患者，根据病因分为原发性二尖瓣反流和继发性二尖瓣反流，并进一步根据入组时间分为常规门诊复查组（2021年6月—2022年10月）和全流程管理组（2022年11月—2023年9月），收集并比较同病因亚组间患者术后1年的随访数据。绘制Kaplan-Meier生存曲线，采用log-rank检验比较2组患者无主要终点事件生存率差异。采用单因素和多因素Cox及logistic回归分析全流程管理模式对患者预后的影响。 结果： 共纳入130例二尖瓣反流患者，年龄（72.0±8.6）岁，男性82例（63%）。原发性反流84例（常规门诊复查组40例，全流程管理组44例），继发性反流46例（常规门诊复查组27例，全流程管理组19例）。Kaplan-Meier曲线显示，无论是原发性还是继发性二尖瓣反流，全流程管理组术后1年无主要终点事件生存率较常规门诊复查组高，但差异无统计学意义（log-rank P>0.05）。与常规门诊复查组相比，全流程管理组纽约心脏协会心功能分级Ⅰ~Ⅱ级患者比例较高（原发性二尖瓣反流：67%比52%，P=0.031；继发性二尖瓣反流：68%比52%，P=0.021）、6 min步行距离较远［原发性二尖瓣反流：（346.39±70.41）m比（294.11±60.47）m，P=0.012；继发性二尖瓣反流：（356.60±54.68）m比（318.55±39.02）m，P=0.004］，KCCQ评分也较高［原发性二尖瓣反流：81.50（74.50，85.00）分比71.00（66.00，82.25）分，P=0.014；继发性二尖瓣反流：83.00（76.00，85.00）分比74.00（70.75，80.00）分，P=0.030］。多因素logistic回归分析显示，全流程管理模式与上述结局改善独立相关（P均<0.05）。 结论： 基于智慧医疗的全流程管理能够改善二尖瓣反流患者TEER术后的心功能和生活质量，且与常规门诊复查相比，接受全流程管理患者的主要终点事件发生率更低。.
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