Search JIM Advanced Search

Journal of Chinese Integrative Medicine ›› 2011, Vol. 9 ›› Issue (7): 725-731.doi: 10.3736/jcim20110705

• Study Protocol • Previous Articles     Next Articles

A study protocol for clinical pathways based on integrative medicine for patients with acute myocardial infarction

Lei Wang, Li-heng Guo, Jun Zhang, Xu-jie Zhao, Min-zhou Zhang()   

  1. Intensive Care Unit, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, Guangdong Province, China
  • Received:2011-04-01 Accepted:2011-04-12 Online:2011-07-20 Published:2011-06-15

Background: Acute myocardial infarction (AMI) is one of the most common cardiovascular diseases. The clinical pathway is the therapeutic program for disease-specific treatment and its implementation may reduce both the duration and cost of the hospital stay. This study aims to construct and evaluate the efficacy of clinical pathways (CPs) based on integrated traditional Chinese and Western medicine for patients with AMI.
Methods and design: The clinical pathway of integrative medicine for AMI was constructed on the basis of syndrome evolvement surveys, literature research and expert consultation. Then, a non-randomized controlled, multicenter trial was designed to evaluate the efficacy and safety of the clinical pathway around the length of hospital stay, hospital expenses and the incidence of major cardiovascular events. This also allowed further exploration into the efficacy and safety of the clinical pathway for AMI based on traditional Chinese and Western medicine.
Discussion: The study firstly researched CPs based on the integrative medicine in hospitals of Chinese medicine and set up the key methods and skills for the construction of CPs of integrative medicine. This study will provide a powerful reference and direction for single-disease management reform under the healthcare system and set a good example for the improvement of integrative treatments.

Key words: myocardial infarction, clinical pathways, TCM WM therapy, evaluation studies

Figure 1

Construction of CPs based on integrative medicine for AMI CPs: clinical pathways; AMI: acute myocardial infarction; TCM: traditional Chinese medicine."

Figure 2

Evaluation of CPs based on integrative medicine for AMI CPs: clinical pathways; AMI: acute myocardial infarction; STEMI: ST-segment elevation myocardial infarction; MACE: major adverse cardiac events."

[1] Moran A, Gu D, Zhao D, Coxson P, Wang YC, Chen CS, Liu J, Cheng J, Bibbins-Domingo K, Shen YM, He J, Goldman L . Future cardiovascular disease in China: Markov model and risk factor scenario projections from the coronary heart disease policy model-china[J]. Circ Cardiovasc Qual Outcomes, 2010,3(3):243-252
doi: 10.1161/CIRCOUTCOMES.109.910711
[2] Hu SL, Gong XG . Economic burden of acute myocardial infarction in China[J]. Zhongguo Wei Sheng Jing Ji, 2003,22(5):32-34
胡善联, 龚向光 . 中国急性心肌梗死的疾病经济负担[J]. 中国卫生经济, 2003,22(5):32-34
[3] Wang SC, Han M, Liu JP . Introduction of clinical pathway and thoughts on its application in Chinese medicine practice[J]. Zhongguo Zhong Xi Yi Jie He Za Zhi, 2009,29(12):1064-1067
王思成, 韩梅, 刘建平 . 临床路径概要及中医临床应用思路[J]. 中国中西医结合杂志, 2009,29(12):1064-1067
[4] Chen YD, Song XT, Lü SZ, Zhu HG, Pan WQ, Ning SQ, Kang TD . Evaluation of varions therapies in patients with acute ST segment elevation myocardial infarction who arrived at hospitals within 12 hours from the onset of chest pain[J]. Zhongguo Jie Ru Xin Zang Bing Xue Za Zhi, 2005,1(1):5-8
doi: 10.3969/j.issn.1004-8812.2005.01.002
陈韵岱, 宋现涛, 吕树铮, 朱华刚, 潘伟琦, 宁尚秋, 康铁朵 . 12小时内就诊的急性心肌梗死患者治疗现状分析[J]. 中国介入心脏病学杂志, 2005,1(1):5-8
doi: 10.3969/j.issn.1004-8812.2005.01.002
[5] Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC Jr, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Ornato JP . ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction)[J]. J Am Coll Cardiol, 2004,44(3):E1-E211
doi: 10.1016/j.jacc.2004.07.014
[6] Wang L, Zhang J, Guo LH, Zhang J, Zhang MZ . Investigation and analysis of acute myocardial infarction scheme based on modified Delphi diagnosis[J]. Zhong Xi Yi Jie He Xin Nao Xue Guan Bing Za Zhi, 2010,8(10):1165-1167
王磊, 张俭, 郭力恒, 张军, 张敏州 . 基于改良德尔菲法对急性心肌梗死中医诊疗方案的调查分析[J]. 中西医结合心脑血管病杂志, 2010,8(10):1165-1167
[7] Wang L, He JZ, Zhang J, Guo LH, Zhang MZ, Chen P, Zhao XJ . An approach to law of distribution and evolvement of syndrome elements during peri-reperfusion period on 218 patients with acute myocardial infarction[J]. Zhongguo Zhong Xi Yi Jie He Ji Jiu Za Zhi, 2010,17(5):267-269
doi: 10.3969/j.issn.1008-9691.2010.05.004
王磊, 何健卓, 张军, 郭力恒, 张敏州, 陈鹏, 招旭杰 . 218例急性心肌梗死围再灌注期中医证候要素变化规律探讨[J]. 中国中西医结合急救杂志, 2010,17(5):267-269
doi: 10.3969/j.issn.1008-9691.2010.05.004
[8] Branch of Cardiovasology of Chinese Association of Integrative Medicine. Traditional Chinese medicine syndrome differentiation standards of coronary heart diseases[J]. Zhongguo Zhong Xi Yi Jie He Za Zhi, 1991,11(5):257
中国中西医结合学会心血管学分会. 冠心病中医辨证标准[J]. 中国中西医结合杂志, 1991,11(5):257
[9] Ministry of Health of the People’s Republic of China. Clinical pathways of 8 diseases announced by Ministry of Health of the People’s Republic of China.[ 2011-4-15]. .
卫生部医政司. 卫生部办公厅关于印发8个病种临床路径的通知[2011-4-15]. .
[10] Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, Hochman JS, Krumholz HM, Lamas GA, Mullany CJ, Pearle DL, Sloan MA, Smith SC Jr; 2004 Writing Committee Members, Anbe DT, Kushner FG, Ornato JP, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B, Tarkington LG, Yancy CW.2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee[J]. Circulation, 2008,117(2):296-329
doi: 10.1161/CIRCULATIONAHA.107.188209
[11] Chen YP, Wong CM, Ou YP, Hu J, Zhang C, Liang LP, Cai ZY . Pilot study for developing inpatient satisfaction questionnaire as an instrument for measuring quality of medical care in general hospitals[J]. Zhongguo Yi Yuan Guan Li, 1999,19(2):15-17
陈平雁, Wong CM, 区燕萍, 胡静, 张超, 梁丽萍, 蔡湛宇 .综合医院住院病人满意度量表研制初报[J]. 中国医院管理, 1999,19(2):15-17
[12] Wang SC, Liu JP, Tang XC, Liu BY, Wu DR, Lü YB .heoretical basis and application of evidence-based clinical pathway of Chinese medicine[J]. Zhongguo Zhong Xi Yi Jie He Za Zhi, 2010,30(4):343-347
王思成, 刘建平, 唐雪春, 刘保延, 吴大嵘, 吕玉波 . 循证中医临床路径构建的理论基础及应用[J]. 中国中西医结合杂志, 2010,30(4):343-347
[13] Gao R, Patel A, Gao W, Hu D, Huang D, Kong L, Qi W, Wu Y, Yang Y, Harris P, Algert C, Groenestein P, Turnbull F; CPACS Investigators . Prospective observational study of acute coronary syndromes in China: practice patterns and outcomes[J]. Heart, 2008,94(5):554-560
doi: 10.1136/hrt.2007.119750
[14] Liu HX, Gao W, Zhao D, Shang JJ, Sun JY . Survey on the hospitalization treatment status of acute myocardial infarction patients in 13 hospitals of Western medicine and traditional Chinese medicine in Beijing[J]. Zhonghua Xin Xue Guan Bing Za Zhi, 2010,38(4):306-310
刘红旭, 高伟, 赵冬, 尚菊菊, 孙佳艺 . 北京地区13家中、西医医院急性心肌梗死患者住院治疗状况调查[J]. 中华心血管病杂志, 2010,38(4):306-310
[15] Ying F, Liu HX, Shang JJ, Zhou Q . A comparative analysis of clinical feature and therapeutic status of in-patients with acute myocardial infarction between traditional Chinese medicine and Western medicine third class hospitals in Beijing area in 2005[J]. Zhongguo Zhong Xi Yi Jie He Ji Jiu Za Zhi, 2009,16(4):206-210
应飞, 刘红旭, 尚菊菊, 周琦 . 2005年北京地区中医院和西医院急性心肌梗死患者住院情况的对比分析[J]. 中国中西结合急救杂志, 2009,16(4):206-210
[16] Wang L, Zhang MZ, Zhang J, Yang G, Tang GH, Guo LH, Chen QF, Zhang J . Establishment and testing practice of an integrative medical pathway for clinical management of acute myocardial infarction[J]. Zhongguo Zhong Xi Yi Jie He Za Zhi, 2011,31(1):7-10
王磊, 张敏州, 张军, 杨广, 唐光华, 郭力恒, 陈全福, 张俭 . 急性心肌梗死中西医结合临床路径的构建及初步评价研究[J]. 中国中西医结合杂志, 2011,31(1):7-10
[1] Fabiana de Almeida Andrade, Caio Fabio Schlechta Portella. Research methods in complementary and alternative medicine: An integrative review. Journal of Integrative Medicine, 2018, 16(1): 6-13.
[2] Yan-bo Zhu , Hideki Origasa, Xiao-xia Luo, Yang-yang Wang , Jie Di , Lin Lin. Responsiveness of three subjective report of outcome measures for chronic heart failure. Journal of Chinese Integrative Medicine, 2012, 10(12): 1375-1381.
[3] Hui-min Liu, Xian-bo Wang, Yu-juan Chang, Li-li Gu. Systematic review and meta-analysis of randomized controlled trials of integrative medicine therapy for treatment of chronic severe hepatitis. Journal of Chinese Integrative Medicine, 2012, 10(11): 1211-1228.
[4] Yan-ming Xie, Xing Liao, Yong-yan Wang. Introduce the idea of comparative effectiveness research to clinical research of Chinese medicine. Journal of Chinese Integrative Medicine, 2011, 9(8): 813-818.
[5] Hui Luo, Jian-ping Liu . Quality and validity of randomized controlled trials in China from the perspective of systematic reviews. Journal of Chinese Integrative Medicine, 2011, 9(7): 697-701.
[6] Ai-ming Wu, Dong-mei Zhang, Li-xia Lou, Jian-ying Zhai, Xi-ying Lü, Li-min Chai, Shuo-ren Wang. Effects of Chinese herbal medicines Shengmai injection and Xuesaitong injection on ventricular fibrillation threshold and connexin 43 expression in rats with myocardial infarction. Journal of Chinese Integrative Medicine, 2011, 9(7): 775-782.
[7] Li-xin Lang, Xiao-bo Wang, Wei Hou. Successful treatment of adult idiopathic pulmonary hemosiderosis with integrated traditional Chinese and Western medicine: A report of one case. Journal of Chinese Integrative Medicine, 2011, 9(5): 531-532.
[8] Shi-jie Zhu , Li-qun Jia, Pei-wen Li. Clinical evaluation of the efficacy of external therapies of traditional Chinese medicine in treatment of cancer pain. Journal of Chinese Integrative Medicine, 2011, 9(1): 11-14.
[9] the Project Group for Demonstration Study of Syndrome Differentiation Protocol Effect Evaluation of Acute Ischemic Stroke, Yan Huang, Jian-wen Guo. Outcome and safety assessment of an herbal medicine treatment protocol for yin pattern of acute ischemic stroke. Journal of Chinese Integrative Medicine, 2010, 8(5): 417-426.
[10] Xue-ying Wang, Jie Wang, Ge Yang, Yong-mei Liu. Effects of Xuesaitong Soft Capsule on hemodynamics and cardiocyte apoptosis of rats after myocardial infarction. Journal of Chinese Integrative Medicine, 2010, 8(3): 269-274.
[11] Yong Miao Edwin. Clinical critical qualitative evaluation of the selected randomized controlled trials in current acupuncture researches for low back pain. Journal of Chinese Integrative Medicine, 2010, 8(12): 1133-1146.
[12] Wei Xu, Meng Shi, Jian-gang Liu, Cheng-long Wang . Collagen protein expressions in ischemic myocardium of rats with acute myocardial infarction and effects of qi-tonifying, yin-tonifying and blood-activating herbs and detoxifying and blood-activating herbs. Journal of Chinese Integrative Medicine, 2010, 8(11): 1041-1047.
[13] Sheng-lei Qiu, Mei Jin, Jing-hong Yi, Tian-gang Zhu, Xin Quan, Yan Liang. Therapy for replenishing qi, nourishing yin and promoting blood circulation in patients with acute myocardial infarction undergoing percutaneous coronary intervention: A randomized controlled trial. Journal of Chinese Integrative Medicine, 2009, 7(7): 616-621.
[14] Xiu-fang Gao, Hai-ming Shi, Tao Sun, Hong Ao. Effects of Radix et Rhizoma Rhodiolae Kirilowii on expressions of von Willebrand factor, hypoxia-inducible factor 1 and vascular endothelial growth factor in myocardium of rats with acute myocardial infarction. Journal of Chinese Integrative Medicine, 2009, 7(5): 434-440.
[15] Ming-wei Wang, Dian-fu Zhang , Jian-jin Tang, Bo Chen , Lian-sheng Wang , Zhi-jian Yang, Jun Huang. Effects of salvianolate on cardiomyocytic apoptosis and heart function in a swine model of acute myocardial infarction. Journal of Chinese Integrative Medicine, 2009, 7(2): 140-144.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] Jun Cai, Hua Wang, Sheng Zhou, Bin Wu, Hua-rong Song, Zheng-rong Xuan. Effect of Sijunzi Decoction and enteral nutrition on T-cell subsets and nutritional status in patients with gastric cancer after operation: A randomized controlled trial. Journal of Chinese Integrative Medicine, 2008, 6(1): 37-40
[2] Dong Yang, Yong-ping Du, Qing Shen, Wei Chen, Yan Yu, Guang-lei Chen. Expression of alpha-smooth muscle actin in renal tubulointerstitium in patients with kidney collateral stasis. Journal of Chinese Integrative Medicine, 2008, 6(1): 41-44
[3] Zhi-chun Jin. Problems in establishing clinical guideline for integrated traditional Chinese and Western medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 5-8
[4] Min Cheng, Qiong Feng, Shu-wen Qian, Hui Gao, Cui-qing Zhu. Preliminary assay of p-amyloid binding elements in heart-beneficial recipe. Journal of Chinese Integrative Medicine, 2008, 6(1): 68-72
[5] Hai-feng Wei, Bai-liu Ya, Ling Zhao, Cui-fei Ye, Li Zhang, Lin Li. Evaluation of tongue manifestation of blood stasis syndrome and its relationship with blood rheological disorder in a rat model of transient brain ischemia. Journal of Chinese Integrative Medicine, 2008, 6(1): 73-76
[6] A-gao Zhou, Yong Zhang, Gang Kui, De-Yun Kong, Hai-liang Ge, Qiu-hua Ren, Jia-rong Dong, Sheng Hong, Xu-ming Mao, Yin Wang, Hui-zheng Zhang, Shu-jun Wang. Influence of traditional Chinese compound recipes with different efficacy on body weight, tumor weight and immune function in H22 cancer-bearing mice. Journal of Chinese Integrative Medicine, 2008, 6(1): 77-82
[7] Xi Lin, Jian-ping Liu. Tai chi for treating rheumatoid arthritis. Journal of Chinese Integrative Medicine, 2008, 6(1): 82
[8] Guo-hong Yuan, Xiao-jing Pang, He-chao Ma. Synergic effects of Danggui Buxue Decoction in reducing toxicity of cytoxan in tumor-bearing mice. Journal of Chinese Integrative Medicine, 2008, 6(1): 83-88
[9] Jin-zhou Tian, Jing Shi, Xin-qing Zhang, Qi Bi, Xin Ma, Zhi-liang Wang, Xiao-bin Li, Shu-li Shen, Lin Li, Zhen-yun Wu, Li-yan Fang, Xiao-dong Zhao, Ying-chun Miao, Peng-wen Wang, Ying Ren, Jun-xiang Yin, Yong-yan Wang, Beijing United Study Group on MCI of the Capital Foundation of Medical Developments. Guiding principles of clinical research on mild cognitive impairment (protocol). Journal of Chinese Integrative Medicine, 2008, 6(1): 9-14
[10] Daniel Weber, Janelle M Wheat, Geoffrey M Currie. Inflammation and cancer: Tumor initiation, progression and metastasis,and Chinese botanical medicines. Journal of Chinese Integrative Medicine, 2010, 8(11): 1006-1013