移动智慧医疗在基层老年慢性病患者心血管病防控中的应用研究

doi:10.12114/j.issn.1007-9572.2023.0206

中国全科医学 ›› 2023, Vol. 26 ›› Issue (33): 4167-4172.DOI: 10.12114/j.issn.1007-9572.2023.0206

移动智慧医疗在基层老年慢性病患者心血管病防控中的应用研究

余新艳¹, 赵珺², 赵晓晔³, 姜清茹¹, 陈雅田⁴, 王艳⁵, 张海澄⁶^,^*()

1．750001　宁夏回族自治区银川市第一人民医院健康管理体检中心
2．225400　江苏省泰兴市人民医院
3．750021　宁夏回族自治区银川市，北方民族大学电气信息工程学院
4．750001　宁夏回族自治区银川市第一人民医院大庙社区卫生服务站
5．750001　宁夏回族自治区银川市第一人民医院新华街社区卫生服务中心
6．100044　北京市，北京大学人民医院心内科

收稿日期:2023-02-20 修回日期:2023-05-20 出版日期:2023-11-20 发布日期:2023-05-31
通讯作者: 张海澄
作者贡献：余新艳负责研究的实施与可行性分析、纳排标准的制定、撰写论文、对主要研究结果进行分析与解释；赵珺负责检索文献、进行图、表绘制，结果的可视化呈现；赵晓晔、刘海鹏负责数据收集整理、统计学处理；姜清茹负责最终版本修订；陈雅田、王艳负责数据核对；张海澄负责提出研究思路，设计研究方案，进行文章的构思与设计、对文章整体负责、监督管理。
基金资助:
国家社会科学基金重大项目(18ZDA086-4); 银川市科技创新重点重大专项(2021-SF-009)

Application of Mobile Smart Healthcare in the Prevention and Control of Cardiovascular Diseases in Elderly Patients with Chronic Diseases in Primary Care

YU Xinyan¹, ZHAO Jun², ZHAO Xiaoye³, JIANG Qingru¹, CHEN Yatian⁴, WANG Yan⁵, ZHANG Haicheng⁶^,^*()

1. Health Management (Physical Examination) Center, the First People's Hospital of Yinchuan, Yinchuan 750001, China
2. Jiangsu Taixing People's Hospital, Taixing 225400, China
3. School of Electrical and Information Engineering, Northern Minzu University, Yinchuan 750021, China
4. Damiao Community Health Station, the First People's Hospital of Yinchuan, Yinchuan 750001, China
5. Xinhua Street Community Health Station, the First People's Hospital of Yinchuan, Yinchuan 750001, China
6. Department of Cardiology, Peking University People's Hospital, Beijing 100044, China

Received:2023-02-20 Revised:2023-05-20 Published:2023-11-20 Online:2023-05-31
Contact: ZHANG Haicheng

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摘要/Abstract

摘要： 背景近年来移动智慧医疗在心血管病的筛查、干预、救治、管理中的优势愈加突出。其中单导联可穿戴心电设备在院外应用于心律失常患者的前期筛查、诊断中的应用价值得到了学者及临床的认可。但因其导联和匹配的云平台功能的单一性，限制了其在基层医疗机构中对慢性非传染疾病（简称慢性病）患者风险筛查及长期随访管理中的应用。目的本研究立足分级诊疗，从慢性病防控的视角，以单导联可穿戴心电设备为载体，探索移动智慧医疗在基层老年慢病患者中心血管病风险防控中的应用价值。方法选取2022年1—8月宁夏回族自治区20家基层医疗机构收治的3 000例65岁及以上慢性病患者为研究对象，其中男1 202例、女1 798例；平均年龄（71.3±5.0）岁。基层医生借助手机APP及患者管理云平台录入患者资料，给患者佩戴单导联可穿戴心电设备采集72 h心电数据上传至患者管理云平台。由专业心电图医生分别对数据进行心律失常、心率变异性（HRV）、阻塞性睡眠呼吸暂停综合征（OSAHS）分析及风险分层，并综合3种分析方法的分层结果将心血管病综合风险符合低、中及高危的数据在云平台勾选相应的标识。云平台对高、中危患者以短信形式通知基层医生对患者进行不同流程的管理。统计3种分析方法不同风险分层患者检出例数，低、中、高危心血管病风险患者检出例数及按流程管理率。结果检出心律失常符合正常、阳性及重大阳性者分别为1 526例（50.87%）、1 349例（44.97%）、125例（4.17%）。2 968例患者完成HRV和OSAHS分析，HRV符合轻度、中度及重度降低者分别为2 330例（78.50%）、630例（21.23%）、8例（0.27%）；OSAHS符合轻度、中度、重度异常者分别1 769例（59.60%）、573例（19.31%）、626例（21.09%）。心血管病综合风险为低、中、高危患者分别为744例（24.80%）、1 640例（54.67%）、616例（20.53%）。心血管病综合风险为高、中、低危患者按流程管理率分别为94.49%（703例）、88.10%（1 445例）、100.00%（616例）。结论将移动智慧医疗技术与心律失常、HRV及OSAHS分析方法联合应用于基层老年慢病患者心血管病防控，心血管病风险检出率和患者管理率较高，有利于基层老年慢性病患者心血管病防控体系的建立。

关键词: 移动医疗, 远程医疗, 单导联可穿戴心电设备, 老年人, 慢性病, 心血管病

Abstract:

Background

The advantages of mobile smart healthcare in screening, intervention, treatment, and management of cardiovascular diseases have become increasingly prominent in recent years. The application value of wearable single lead electrocardiogram equipment in the early screening and diagnosis of arrhythmia patients out of the hospital has been recognized by scholars and clinical workers. However, its application in risk screening and long-term follow-up management of chronic disease patients in primary care is limited by the single function of the cloud platform led and matched by it.

Objective

To explore the application value of mobile smart healthcare in the prevention and control of cardiovascular disease risk in elderly patients with chronic disease in primary care from the perspective of chronic disease prevention and control and using wearable single lead electrocardiogram equipment as carriers, based on hierarchical medical system.

Methods

A total of 3 000 patients with chronic disease aged above 65 years admitted to primary care institutions in Ningxia from January 2022 to August 2022 were selected as research subjects, including 1 202 males and 1 798 females with an average age of (71.3±5.0) years. The baseline data were recorded by primary care physicians through mobile phone APP and cloud platform of patient management, 72-hour ECG data collected by wearable single lead electrocardiogram equipment were also uploaded to cloud platform of patient management. Analysis of data and risk stratification for arrhythmia, heart rate variability (HRV) and obstructive sleep apnea hypopnea syndrome (OSAHS) were performed by professional electrocardiographers, and the corresponding marks on the cloud platform for the data with low, medium and high risk of cardiovascular disease were ticked according to the stratification results of the three analysis methods. The cloud platform notifies primary care physicians of high and medium risk data in the form of SMS for the management of different processes of patients. The number of detected cases with different risk stratification, the number of detected cases and rates of management according to the process among patients with low, medium and high risk of cardiovascular disease were counted.

Results

Arrhythmias were detected in 1 526 (50.87%), 1 349 (44.97%), and 125 (4.17%) cases consistent with negativity, positivity, and significant positivity, respectively; HRV was mildly, moderately, and severely reduced in 2 330 (78.50%), 630 (21.23%), and 8 (0.27%) cases, respectively; OSAHS was consistent with mild, moderate, and severe abnormalities in 1 769 (59.60%), 573 (19.31%), and 626 (21.09%) cases, respectively. The comprehensive risk of cardiovascular disease was low, moderate, and high in 744 (24.80%), 1 640 (54.67%), and 616 (20.53%) patients, respectively. The rates of management according to the process in patients with high, medium and low comprehensive risk of cardiovascular disease were 94.49% (703 cases), 88.10% (1 445 cases) and 100% (616 cases), respectively.

Conclusion

The elderly patients with chronic disease in primary care with combined application of mobile smart healthcare technology and arrhythmia, HRV, OSAHS analysis methods to the prevention and control of cardiovascular diseases have higher detection rate of cardiovascular disease risk and management rate, which is conducive to the establishment of a cardiovascular disease prevention and control system for them.

Key words: Mobile health, Telehealth, Single-lead wearable ECG equipment, Aged, Chronic disease, Cardiovascular diseases

余新艳,赵珺,赵晓晔,等. 移动智慧医疗在基层老年慢性病患者心血管病防控中的应用研究[J]. 中国全科医学, 2023, 26(33): 4167-4172. DOI: 10.12114/j.issn.1007-9572.2023.0206.
YU Xinyan,ZHAO Jun,ZHAO Xiaoye, et al. Application of Mobile Smart Healthcare in the Prevention and Control of Cardiovascular Diseases in Elderly Patients with Chronic Diseases in Primary Care[J]. Chinese General Practice, 2023, 26(33): 4167-4172. DOI: 10.12114/j.issn.1007-9572.2023.0206.

图/表 2

图1 高、中、低危患者管理路径流程

Figure 1 Management pathway process for high，medium，and low risk patients

表1 中、高危心血管病综合风险患者管理率统计〔例（%）〕

Table 1 Statistics on the management rate of patients with medium and high comprehensive risk

项目	中危（n=1 640）		高危（n=744）
项目	例数	按流程管理率	例数	按流程管理率
符合1项	1 148	1 006（87.63）	729	688（94.38）
符合2项	466	413（89.05）	15	15（100.00）
符合3项	26	26（100.00）	0

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移动智慧医疗在基层老年慢性病患者心血管病防控中的应用研究

Application of Mobile Smart Healthcare in the Prevention and Control of Cardiovascular Diseases in Elderly Patients with Chronic Diseases in Primary Care

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