CN107145755A - Cardiovascular chronic diseases management method based on Intelligent Decision Support Technology - Google Patents
Cardiovascular chronic diseases management method based on Intelligent Decision Support Technology Download PDFInfo
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- CN107145755A CN107145755A CN201710341737.3A CN201710341737A CN107145755A CN 107145755 A CN107145755 A CN 107145755A CN 201710341737 A CN201710341737 A CN 201710341737A CN 107145755 A CN107145755 A CN 107145755A
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Abstract
The invention discloses a kind of cardiovascular chronic diseases management method based on Intelligent Decision Support Technology, comprise the following steps：S1, establishment patient health archives；S2, angiocardiopathy thrombus and bleeding risk are assessed；S3, the tracking of anticoagulant therapy curative effect and drug discontinuation risk profile；Rear structuring disease that calls for specialized treatment long term follow-up is examined in S4, cardiovascular patient discharge；S5, doctor support；S6, patient support.The present invention merges internet communication technology, sets up risk warning model, data analysis and authoritative angiocardiopathy administration guide, build the Treatment decsion flow that a set of real time data is supported, dynamic monitoring patient risk changes, it is the Self-management approach that joint physician guidance plus patient participate in, utilize Data Analysis Model, the assessment of angiocardiopathy relevant risk, the tracking for the treatment of cardiovascular disease effect are provided, and according to patient's own situation, it is automatic to capture and provide the long-term self-management of patient personalized risk inventory, patient safety medication is helped, is improved the quality of living.
Description
Technical field
The present invention relates to internet portable medical technical field, more particularly to a kind of heart based on Intelligent Decision Support Technology
Blood vessel chronic diseases management method.
Background technology
Chronic disease has turned into the number one killer of global residents ' health, and it is always dead that cardiovascular and cerebrovascular diseases chronic diseases account for China resident
79.4%.Just there are 2 to die from cardiovascular disease in every 5 death.The existing cardiovascular patient 2.9 hundred million in the whole nation, wherein high blood
Press 2.7 hundred million, cerebral apoplexy 7,000,000, myocardial infarction 2,500,000, heart failure 4,500,000.China is used for heart and brain in 1 year at present
The medical expense of vascular diseases is up to 300,000,000,000 RMB, and the increase of Chinese Adult cardiovascular disease event will in prediction next two decades
More than 50%, about increase by 21,300,000, serious society, economic and health burden will be caused.Effective chronic diseases management mould is there is no at present
Formula.
On the one hand, the slow disease increase of angiocardiopathy and risk factors of cardiovascular diseases, including hypertension, dyslipidemia, sugar
Urine is sick, and the slow diseased state such as metabolic syndrome is not effectively treated relevant.On the other hand, diagnosis of cardiovascular slow patient group, no
Conscience vascular events fail effective containment, and above-mentioned phenomenon is embodied in cardiovascular slow sick awareness, and treatment rate treats control rate
（27.4%）It is not enough.Patient's hospitalization it is not yet in effect reduction long-term cardiovascular event risk the reason for also include patient discharge after
Effective doctor patient communication is lost, curative compliance declines, fails to carry out effective secondary prevention.
In addition, the present situation of China is medical and health resource gross shortage, high-quality medical resource is mainly distributed on big and medium-sized cities,
The unreasonable Allocation of Medical Resources structure formed for a long time, the high-quality resource Urban-rural Difference drop formed is bigger.Although realizing excellent
The accessibility and isotropism of matter medical resource are always the target of Government Medical reform, but difficulty is very big.By taking 301 Hospital as an example,
With 4000 beds, total Number of Outpatients of 2014 reaches 4,000,000, treats a patient more than 3000 day.In face of such severe heart
The soaring present situation of vascular diseases burden, needs the national conditions explored and how combined instantly badly, and the high-quality resource of large hospital and medical treatment are taken
Business extension, inquires into the overall management strategy of disease and applicable scheme of high-efficiency and low-cost, and management and control " disease chain " is from preventing controlling
Node, intervention to angiocardiopathy continuous and effective is realized, so as to reduce government's medical insurance expenditure, society and family burden.
With mobile and development communication technologies, new technology attempts the management for disease.However, existing internet skill
Application of the art in medical field is limited to " picture and text consulting ", " telephone counseling ", " information reminding " etc., and these are phone or short
The extension of telecommunication function, has not given play to portable medical technology potential advantages.Based on this, we, which build, is based on intelligence decision support system skill
The cardiovascular disease management method of art, it is intended to help the effective self-management of angiocardiopathy crowd, healthy living.
There is provided common angiocarpy using Data Analysis Model for cardiovascular disease management method based on Intelligent Decision Support Technology
Disease risks are assessed, therapeutic effect tracking, and according to patient's own situation, Auto-matching simultaneously provides patient long-term self-management
Property the dangerous inventory of wind transmission, help patient safety medication, improve the quality of living.
Key technology, the problem of intending to solve below so that atrial fibrillation is managed as an example to the present invention is illustrated.
Atrial fibrillation is most common arrhythmia cordis symptom, and cerebral apoplexy and thrombus are the major complications of atrial fibrillation.Entirely
Ball Disease Spectrum database analysis shows that whole world atrial fibrillation illness rate is 0.5% at present, with aging, global atrial fibrillation
Burden will increase.Current China there are about 10,000,000 atrial fibrillation crowds, Chinese atrial fibrillation and its related cerebral apoplexy burden increase
Significantly, nearly 11 years atrial fibrillation illness rates increase by 20 times, and atrial fibrillation cerebral apoplexy increases by 13 times.Chinese atrial fibrillation people group mean
Anti-freezing rate fails effectively to prevent and treat the harm of the complication such as atrial fibrillation and its cerebral apoplexy less than 20%.With new oral anticoagulant
Listing, anticoagulant therapy has safer selection.However, how to make good use of medicine, help patient to obtain anti-freezing to greatest extent and obtain
The problem of benefit is clinician and patient's urgent need to resolve, the problem of these safe medications are actual includes anti-freezing policy selection, suffered from
Person's drug compliance and medicine bleeding risk long-period of management etc..Above-mentioned deficiency, is not only embodied in patient assessment or hospital stay
Between, especially it is embodied in the long-period of management after patient discharge, patient is often difficult to the treatment for obtaining continuous and effective.
The content of the invention
The invention aims to research and develop intelligent decision support system, by capturing patient characteristic data, automatic measurement ＆ calculation
Angiocardiopathy（Such as atrial fibrillation）Relevant risk, tracks anticoagulant therapy effect, and the personalized risk inventory of matching helps angiocardiopathy
（Such as atrial fibrillation）Patient carries out examining the self-management after rear/discharge, and the angiocarpy based on Intelligent Decision Support Technology proposed is slow
Sick management method.
Cardiovascular chronic diseases management method based on Intelligent Decision Support Technology, comprises the following steps：
S1, using the healthy angiocardiopathy management intelligent decision support system of the heart facilitate doctor or patient cardiovascular with heart health
Disease disease that calls for specialized treatment formats health account and creates patient health archives；
S2, set up angiocardiopathy thrombus using the healthy angiocardiopathy management intelligent decision support system of the heart and bleeding risk is commented
Estimate mathematical modeling, and use the patient health archives phase created in intelligent auto-associating and data processing technique, invocation step S1
The Data Elements of pass, are automatically matched to angiocardiopathy thrombus and bleeding risk assesses key element, and match corresponding cardiovascular disease
Sick management method；
S3, in step s 2 on the basis of, utilize the healthy angiocardiopathy management intelligent decision support system of the heart to complete cardiovascular
The tracking of disease anticoagulant therapy curative effect, assessment and drug discontinuation risk profile；
When S4, cardiovascular patient are left hospital or examine rear structuring disease that calls for specialized treatment long term follow-up support system by patient assessment or discharge
Between, it is automatic to calculate follow-up of patients's time, according to the clinical risk factors of patient, treatment, Auto-matching follow-up of patients's content,
Including drug therapy situation, Cardioversion, bleeding episode, health assessment, heart health angiocardiopathy manages App utility efficiencies,
Anti-freezing satisfaction etc., leaves hospital to cardiovascular patient or examines rear structuring disease that calls for specialized treatment long term follow-up；
S5, doctor support；
S6, patient support.
It is preferred that, the healthy angiocardiopathy management intelligent decision support system of the heart in the step S1 is to be based on third party
OCR intelligent identification technologies, the system with the intelligent picture and text identification functions of OCR of orientation exploitation, its picture and text recognition accuracy reaches
More than 90%；Based on third party's speech recognition technology, the system with voice conversion and identification function of exploitation can be by voice text
Part is converted to text information, and its mandarin recognition accuracy reaches more than 95%；Heart health angiocardiopathy management intelligent decision branch
The system of holding has also set up the medical vocabulary dictionary storehouse such as expert knowledge library and all kinds of symptoms, disease, medicine, with semantic analysis work(
Energy.
It is preferred that, the healthy angiocardiopathy management intelligent decision support system of the heart in the step S1 includes following spy
Levy：
A, the risk assessment flow recommended according to authoritative angiocardiopathy administration guide carry out risk assessment, including thrombus and bleeding
Risk；
The healthy angiocardiopathy management intelligent decision support system of b, the heart is obtained after scoring key element, estimated risk automatically, into making
With traditional anticoagulant outcome prediction stage；
The healthy angiocardiopathy management intelligent decision support system of c, the heart is completed after traditional anticoagulant outcome prediction evaluation, will be controlled
Treat decision probability, advantage and disadvantage and return to doctor or patient, help doctor or patient's decision-making.
It is preferred that, the healthy angiocardiopathy disease that calls for specialized treatment of the heart in the step S1 formats health account and specially set for the present invention
That counts includes angiocardiopathy and angiocardiopathy relevant disease, angiocardiopathy operation, apparatus or drug therapy relevant factor
Archives, the Intelligent Recognition matching technique of angiocardiopathy relevant disease key element is added for doctor or patient.
It is preferred that, the discharge of cardiovascular patient in the step S4 or examine rear structuring disease that calls for specialized treatment long term follow-up and support system
System includes following characteristics：A, cardiovascular patient treatment, angiocardiopathy disease cognitive and drug therapy situation, including
Withdraw, miss, using other medicines and its reason etc. instead；B, patient's treatment curative effect structuring follow-up, including thrombus, bleeding episode；
C, based on patient's Current therapeutic, investigation patient's anticoagulant therapy satisfaction and quality of life condition.
It is preferred that, the doctor in the step S5 supports to include following characteristics：A, medical decision making are supported；B, guide common recognition；
C, Experts ' Comments；D, much-talked-about topic；E, clinical experience are shared；F, meeting information；G, real time patient's treatment statistical analysis.
It is preferred that, the patient in the step S6 supports to include following characteristics：A, survey risk；B, safe drugs treatment；
C, live Patients ' Healthy Education.
The invention belongs to internet portable medical field, for angiocardiopathy（Such as atrial fibrillation）Carry out risk assessment, early warning,
Treatment decsion is supported and long-term safety treatment is instructed, and the present invention merges internet communication technology, sets up risk warning model, number
According to analysis and authoritative atrial fibrillation administration guide, the Treatment decsion flow that a set of real time data is supported, dynamic monitoring patient risk are built
Change, the self-management that joint physician guidance+patient participates in, is a kind of brand-new angiocardiopathy（Such as atrial fibrillation）Management system and
Method.The inventive method, using mobile terminal APP, computer platform end as aid, is angiocardiopathy（Such as atrial fibrillation）Patient provides
Safely and effectively treat.
Application of the existing Internet technology in medical field be limited to " picture and text consulting ", " telephone counseling ", " information is carried
Wake up " etc., these are the extension of phone or SMS, have not given play to portable medical technology potential advantages.The present invention is mobile
Terminal Design is on the basis of possessing " picture and text consulting ", " telephone counseling ", " information reminding " basic function, using data correlation, certainly
It is dynamic to match critical data key element, set up and realize angiocardiopathy（Such as atrial fibrillation）Thrombus, bleeding risk are assessed and anticoagulant therapy is treated
Effect prediction, builds angiocardiopathy（Such as atrial fibrillation）The DSS that guide is recommended, as doctor or patient press flow scheme design
Set up after health account, angiocardiopathy is carried out successively（Such as atrial fibrillation）Risk assessment and Treatment decsion curative effect evaluation, and according to trouble
Person's merging disease feature and the therapeutic scheme received, automatic setting structure follow-up task, in the case where doctor supports and patient supports,
Control hazards, optimization long-term safety treatment.
Brief description of the drawings
Fig. 1 is the technical scheme stream of the cardiovascular chronic diseases management method proposed by the present invention based on Intelligent Decision Support Technology
Cheng Tu.
Embodiment
Reference picture 1, makees further to explain with reference to specific embodiment to the present invention.
With reference to the Treatment decsion flow instance to a cardiovascular patient, it is described in detail proposed by the present invention based on intelligence
The cardiovascular chronic diseases management method of energy decision support technique, it comprises the following steps：
S1, doctor or patient use mobile terminal, including apple or Android smartphone, are designed according to angiocardiopathy management platform
Angiocardiopathy diseased structures medical records system, set up health account；
The Data Elements that the healthy angiocardiopathy management platform automatic identification Data Elements of S2, the heart, matching risk assessment need；
The healthy angiocardiopathy management platform DSS work of S3, the heart, completes angiocardiopathy thrombotic risk
（CHA2DS2-VASc）Assess, angiocardiopathy bleeding risk（HAS-BLED）Assess, angiocardiopathy anticoagulant therapy curative effect with
Track decision support, and drug discontinuation risk profile support system；
The healthy angiocardiopathy management platform of S4, the heart presses patient assessment or discharge time, and automatic calculating patient answers follow up time, root
According to the clinical risk factors of patient, treatment, Auto-matching follow-up of patients's content, including drug therapy situation, Cardioversion,
Bleeding episode, health assessment, heart health angiocardiopathy management App utility efficiencies, anti-freezing satisfaction etc.；
S5, in follow up time the last week, mobile terminal sends follow-up and reminded, and patient completes corresponding follow-up by the follow-up plan of setting
Task；
S6, doctor are received after the follow-up task of patient's completion, are linked up with patient in information platform, and information platform provides common painstaking effort
Pipe disease relevant clinical questionnaire, facilitates doctor efficiently to understand conditions of patients change, adjusts patient treatment protocol；
S7, doctor's medical decision making are supported, including the decision support tool under different clinical settings, help doctor's decision-making.Such as painstaking effort
Pipe disease surgery patient's anticoagulant therapy decision-making, the support of valvular cardiovascular patient Treatment decsion etc.；
S8, doctor team and doctor and expert initiate case history discussion, filing；
S9, patient support：Including merging disease with patient, the personalized patient risk that therapeutic scheme matches is tested, scene is good for
Kang Jiaoyu recommendations etc..
S3 cardiovascular diseases（Such as atrial fibrillation）Relevant risk appraisal procedure is as follows：
Set up risk of cardiovascular diseases and assess general version, illustrate that relevant risk is assessed by taking atrial fibrillation as an example.Set up atrial fibrillation thrombus and
Bleeding risk evaluates mathematical modeling, using intelligent auto-associating and data processing technique, calls the health account set up related
Data Elements, be automatically matched to angiocardiopathy（Such as atrial fibrillation）Thrombus and bleeding risk essential elements of evaluation, the cardiovascular disease of heart health
Sick management platform goes out patient's thrombus and bleeding risk in mobile terminal automatic measurement ＆ calculation, and matches corresponding angiocardiopathy（Such as atrial fibrillation）Pipe
Reason method.
（1）Atrial fibrillation thrombus（CHA2DS2-VASc）Assess
1）Assessment tool is defined：
A, H, C, D, Sc, V then represent age ＞ 65 years old, hypertension, heart failure, diabetes, women and vascular diseases etc., blood respectively
Pipe disease refers to myocardial infarction, compound Aortic Plaque and peripheral arterial disease, and this several represent 1 point respectively.
S2 and A2 are represented respectively previously thromboembolism medical history and age >=75 year old.This two factors can be multiplied trouble
The risk of person's thromboembolism, is the Major Risk Factors of patients with atrial fibrillation thromboembolism, so this two scoring is respectively 2 points.Most
Higher assessment is divided into 9 points.
2）Assessment result is explained：
CHA2DS2-VASc=0：The low danger of thrombus, is not required to reinforcing management.
CHA2DS2-VASc=1（Male）, CHA2DS2-VASc=2（Women ＜ 65 years old）：Endangered in thrombus, need management.
CHA2DS2-VASc ＞ 2：Thrombus is high-risk, it is proposed that reinforcing management.
（2）Atrial fibrillation bleeding risk（HAS-BLED）Assess
Set up and realize that mobile terminal atrial fibrillation bleeding risk assesses mathematical modeling (HAS-BLED), using intelligence measuring technology, calculate
Atrial fibrillation related hemorrhages risk, and match corresponding management measure.
1）Assessment tool is defined：
Hypertension (H), abnormal hepatic and renal function (A), palsy (S), bleeding (B), INR values are unstable (L), old ＞ 65 years old (E),
Medicine, drink (D).Medicine, each 1 point of meter of drinking, abnormal hepatic and renal function respectively count 1 point (A), remaining each 1 point of meter.
2）Assessment result is explained：
The low danger of HAS-BLED=0-1 bleeding risks
Endangered in the bleeding risk of HAS-BLED=2
HAS-BLED >=3 bleeding risks are high-risk
The anti-bolt management intelligent decision support system of atrial fibrillation in the present embodiment uses warfarin outcome prediction system：
Traditional anticoagulant warfarin interacts because of its pharmacology with multi-medicament food, there is " magnificent method in Clinical practice
Woods predicament ", i.e. INR are fluctuated, and patient uses warfarin treatment, but before being difficult to reach desired value, use Anticoagulation of Warfarin
Outcome prediction instrument（SAMe-TT2R2 scores）, help patient to be predicted before using warfarin using whether warfarin can reach
To good anticoagulant therapy effect.
The present invention sets up atrial fibrillation anticoagulant therapy DSS-tradition anticoagulant warfarin outcome prediction system, makes
With intelligent auto-associating and data processing technique, the Data Elements for calling the health account set up related are automatically matched to room
Quiver thrombus and bleeding risk essential elements of evaluation, and heart health atrial fibrillation management platform goes out warfarin outcome prediction system in mobile terminal automatic measurement ＆ calculation
System.
1）Assessment tool is defined：
Sex, women scores 1 point；Age, age≤60 year old are scored 1 point；Medical, medical history：Any 2 kinds of diseases（High blood
Under pressure, diabetes, coronary heart disease/heart infarction, peripheral arterial disease, heart failure, the past cerebral apoplexy, lung disease, liver or renal function
Drop）, score 1 point；Treatment, treatment（Merge the medicine using the control rhythm of the heart such as amiodarone）, score 1 point；Tobacco,
Current smoking, scores 2 points；Race, race（Non-white group）, score 2 points.
2）Assessment result is explained：
SAMe-TT2R2 ＜ 2:Warfarin anti-freezing can obtain good anti-freezing quality.
SAMe-TT2R2 ＞ 2:Warfarin anti-freezing is more difficult to obtain good anti-freezing quality, it is necessary to pay close attention to atrial fibrillation relevant risk
Management.
Medicine disruption risk Forecasting Support System in the present embodiment：
Assess cardiovascular patient and adhere to treatment, remind Patient drug to interrupt Operative risk.Drug compliance refers to suffer from
Person adheres to drug administration according to prescription.Drug compliance declines, and shows that patient interrupts medication, or miss medicine.Medicine is complied with
Property decline increase Cardia cevent, including coronary artery thrombus, atrial fibrillation thrombotic risk.
U.S.'s medical insurance is more than 60,000 people oral anticoagulation therapy patient datas, and display disables oral anticoagulation thing 1-3 months, blood
Bolt risk increases by 2 times；The 3-6 months are disabled, thrombotic risk increases by 3 times；Disable more than June, thrombotic risk increases by 4 times.
The present invention sets up in mobile terminal and realizes drug discontinuation risk profile instrument, allows patient to understand drug discontinuation risk,
Improve curative compliance.
（1）Drug discontinuation risk profile supports that system design problem is as follows：
The adverse drug reaction that my worry of problem 1. is taken is by more than the benefit brought
1）Agree to 2）Some agree to 3）Disagree
The importance of I Understand the drug administration of problem 2.
1）Agree to 2）Some agree to 3）Disagree
Problem 3. I feel to continue to take these medicines and have economic pressures
1）Agree to 2）Some agree to 3）Disagree
（2）Scoring rule：
Problem 1. is scored：
1-14 points 2-4 points 3-0 points
Problem 2. is scored：
1-0 points 2-7 points 3-20 points
Problem 3. is scored：
1-2 points 2-0 points 3-0 points
（3）As a result explain：
0 compliance of scoring is good（>75% may adhere to medication）
Compliance reduction that the 2-7 that scores is slight（32-75% may adhere to medication）
Score 8-36 compliances are decreased obviously（<32% may adhere to medication）
The foregoing is only a preferred embodiment of the present invention, but protection scope of the present invention be not limited thereto, it is any
Those familiar with the art the invention discloses technical scope in, technique according to the invention scheme and its invention
Design is subject to equivalent substitution or change, should all be included within the scope of the present invention.
Claims (7)
1. the cardiovascular chronic diseases management method based on Intelligent Decision Support Technology, it is characterised in that comprise the following steps：
S1, using the healthy angiocardiopathy management intelligent decision support system of the heart facilitate doctor or patient cardiovascular with heart health
Disease disease that calls for specialized treatment formats health account and creates patient health archives；
S2, set up angiocardiopathy thrombus using the healthy angiocardiopathy management intelligent decision support system of the heart and bleeding risk is commented
Estimate mathematical modeling, and use the patient health archives phase created in intelligent auto-associating and data processing technique, invocation step S1
The Data Elements of pass, are automatically matched to angiocardiopathy thrombus and bleeding risk assesses key element, and match corresponding cardiovascular disease
Sick management method；
S3, in step s 2 on the basis of, utilize the healthy angiocardiopathy management intelligent decision support system of the heart to complete cardiovascular
The tracking of disease anticoagulant therapy curative effect, assessment and drug discontinuation risk profile；
When S4, cardiovascular patient are left hospital or examine rear structuring disease that calls for specialized treatment long term follow-up support system by patient assessment or discharge
Between, it is automatic to calculate follow-up of patients's time, according to the clinical risk factors of patient, treatment, Auto-matching follow-up of patients's content；
S5, doctor support；
S6, patient support.
2. the cardiovascular chronic diseases management method according to claim 1 based on Intelligent Decision Support Technology, it is characterised in that
The healthy angiocardiopathy management intelligent decision support system of the heart in the step S1 is to be based on third party's OCR Intelligent Recognition skills
Art, the system with the intelligent picture and text identification functions of OCR of orientation exploitation, its picture and text recognition accuracy reaches more than 90%；Based on
Tripartite's speech recognition technology, the system with voice conversion and identification function of exploitation, can be converted to voice document in word letter
Breath, its mandarin recognition accuracy reaches more than 95%；Heart health angiocardiopathy management intelligent decision support system has been also set up
Expert knowledge library and medical vocabulary dictionary storehouse, with semantic analysis function.
3. the cardiovascular chronic diseases management method according to claim 1 based on Intelligent Decision Support Technology, it is characterised in that
The healthy angiocardiopathy management intelligent decision support system of the heart in the step S1 includes following characteristics：A, according to authoritative painstaking effort
The risk assessment flow that pipe disease control guide is recommended carries out risk assessment, including thrombus and bleeding risk；The healthy painstaking effort of b, the heart
Pipe disease control intelligent decision support system is obtained after scoring key element, estimated risk automatically, is treated into using traditional anticoagulant
Imitate forecast period；The healthy angiocardiopathy management intelligent decision support system of c, the heart completes traditional anticoagulant outcome prediction and evaluated
Afterwards, Treatment decsion probability, advantage and disadvantage are returned into doctor or patient, helps doctor or patient's decision-making.
4. the cardiovascular chronic diseases management method according to claim 1 based on Intelligent Decision Support Technology, it is characterised in that
The healthy angiocardiopathy disease that calls for specialized treatment of the heart in the step S1 formats health account includes angiocarpy for what the present invention was specially designed
Disease and angiocardiopathy relevant disease, angiocardiopathy operation, the archives of apparatus or drug therapy relevant factor, for doctor
Or patient adds the Intelligent Recognition matching technique of angiocardiopathy relevant disease key element.
5. the cardiovascular chronic diseases management method according to claim 1 based on Intelligent Decision Support Technology, it is characterised in that
Cardiovascular patient discharge in the step S4 examines rear structuring disease that calls for specialized treatment long term follow-up and supports system to include following characteristics：
A, cardiovascular patient treatment, angiocardiopathy disease cognitive and drug therapy situation；B, patient's treatment curative effect structure
Change follow-up；C, based on patient's Current therapeutic, investigation patient's anticoagulant therapy satisfaction and quality of life condition.
6. the cardiovascular chronic diseases management method according to claim 1 based on Intelligent Decision Support Technology, it is characterised in that
Doctor in the step S5 supports to include following characteristics：A, medical decision making are supported；B, guide common recognition；C, Experts ' Comments；D, heat
Point topic；E, clinical experience are shared；F, meeting information；G, real time patient's treatment statistical analysis.
7. the cardiovascular chronic diseases management method according to claim 1 based on Intelligent Decision Support Technology, it is characterised in that
Patient in the step S6 supports to include following characteristics：A, survey risk；B, safe drugs treatment；C, live patient health religion
Educate.
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