Objective: This meta-analysis aimed to assess and evaluate the effect of nurse-led health management on the quality of life of patients with atrial fibrillation. Methods: We compared the outcomes of patients who received nurse-led intervention during hospitalization with those who did not, using a systematic retrospective and randomized controlled trial (RCT) analysis. We searched the studies in Cochrane Central Register, including PubMed, EmBase, Web of Science, Cochrane Library, WAN Data, CBM, CNKI, etc. Bias risks included in the study were evaluated by Cochrane Bias risk tool , and combined risk estimates were calculated. The main endpoints are the SF-36 and HADS scores and endpoints after surgery. We used a random effects model to combine the data. For continuous variables (such as SF-36 and HADS scores), we used standard mean difference for analysis, and for binary variables (such as the presence or absence of mental health problems), we used hazard ratio for analysis. The data are based on fixed or stochastic effects models, with standard mean differences and risk ratios for continuous and heterotaxic variables. Results: 3064 patients from 7 clinical studies were included in this meta-analysis. Postoperative SF-36 scores at 6 months in the nurse-led group were significantly higher than those in the routine nursing group in Role-Physical and Mental health. Postoperative SF-36 scores at 12 months in the nurse-led group were not significantly higher than those in the routine nursing group. The nurse-led group had a significantly lower HADS depression score than the conventional care group, but there was no significant difference in HADS anxiety score between the two groups. Conclusion: The main findings of this meta-analysis are that the nurse-led comprehensive management of atrial fibrillation can significantly improve the role-physical and mental health status of SF-36, reduce the HADS depression score, the incidence of cardiovascular hospitalization and atrial fibrillation at 6 months atrial fibrillation surgery. Additional high-quality RCTs should be conducted in the future. nurse-led interventions have the potential to significantly impact the care of patients with atrial fibrillation. By providing comprehensive management, education, and support, nurses can improve patient outcomes, enhance quality of life, and reduce healthcare burdens for both patients and providers. While this meta-analysis provides valuable insights, there are limitations that should be considered. Standardizing interventions and outcome measures, conducting larger studies with longer follow-up periods, including diverse populations and settings, and assessing the economic impact of nurse-led interventions are potential directions for future research in this field. Addressing these limitations would provide a more comprehensive understanding of the role of nurse-led interventions in the care of patients with atrial fibrillation.

Objective:To compare the benefits and harms of drug treatments for adults with type 2 diabetes, adding non-steroidal mineralocorticoid receptor antagonists (including finerenone) and tirzepatide (a dual glucose dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonist) to previously existing treatment options. Design:Systematic review and network meta-analysis. Data sources:Ovid Medline, Embase, and Cochrane Central up to 14 October 2022. Eligibility criteria for selecting studies:Eligible randomised controlled trials compared drugs of interest in adults with type 2 diabetes. Eligible trials had a follow-up of 24 weeks or longer. Trials systematically comparing combinations of more than one drug treatment class with no drug, subgroup analyses of randomised controlled trials, and non-English language studies were deemed ineligible. Certainty of evidence was assessed following the GRADE (grading of recommendations, assessment, development and evaluation) approach. Results:The analysis identified 816 trials with 471 038 patients, together evaluating 13 different drug classes; all subsequent estimates refer to the comparison with standard treatments. Sodium glucose cotransporter-2 (SGLT-2) inhibitors (odds ratio 0.88, 95% confidence interval 0.83 to 0.94; high certainty) and GLP-1 receptor agonists (0.88, 0.82 to 0.93; high certainty) reduce all cause death; non-steroidal mineralocorticoid receptor antagonists, so far tested only with finerenone in patients with chronic kidney disease, probably reduce mortality (0.89, 0.79 to 1.00; moderate certainty); other drugs may not. The study confirmed the benefits of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing cardiovascular death, non-fatal myocardial infarction, admission to hospital for heart failure, and end stage kidney disease. Finerenone probably reduces admissions to hospital for heart failure and end stage kidney disease, and possibly cardiovascular death. Only GLP-1 receptor agonists reduce non-fatal stroke; SGLT-2 inhibitors are superior to other drugs in reducing end stage kidney disease. GLP-1 receptor agonists and probably SGLT-2 inhibitors and tirzepatide improve quality of life. Reported harms were largely specific to drug class (eg, genital infections with SGLT-2 inhibitors, severe gastrointestinal adverse events with tirzepatide and GLP-1 receptor agonists, hyperkalaemia leading to admission to hospital with finerenone). Tirzepatide probably results in the largest reduction in body weight (mean difference -8.57 kg; moderate certainty). Basal insulin (mean difference 2.15 kg; moderate certainty) and thiazolidinediones (mean difference 2.81 kg; moderate certainty) probably result in the largest increases in body weight. Absolute benefits of SGLT-2 inhibitors, GLP-1 receptor agonists, and finerenone vary in people with type 2 diabetes, depending on baseline risks for cardiovascular and kidney outcomes (https://matchit.magicevidence.org/230125dist-diabetes). Conclusions:This network meta-analysis extends knowledge beyond confirming the substantial benefits with the use of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing adverse cardiovascular and kidney outcomes and death by adding information on finerenone and tirzepatide. These findings highlight the need for continuous assessment of scientific progress to introduce cutting edge updates in clinical practice guidelines for people with type 2 diabetes.