Prognostic importance of emotional support for elderly patients hospitalized with heart failure.
Prognostic importance of emotional support for elderly patients hospitalized with heart failure.
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DOI：
10.1161/01.cir.97.10.958
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发表时间：
1998-03
期刊：
影响因子：
37.8
通讯作者：
H. Krumholz;J. Butler;Jeremy A Miller;V. Vaccarino;Christianna S. Williams;Carlos F. Mendes Leon;T. Seeman;S. Kasl;L. Berkman
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文献类型：
--
作者：
H. Krumholz;J. Butler;Jeremy A Miller;V. Vaccarino;Christianna S. Williams;Carlos F. Mendes Leon;T. Seeman;S. Kasl;L. Berkman
一些研究表明，各种社会关系是冠心病患者发病率和死亡率的重要预测因素，但很少有人关注这些因素在不断增长的老年心力衰竭患者中的预后重要性。为了解决这个问题，我们试图确定情感支持是否与老年心力衰竭住院患者的致命性和非致命性心血管事件有关。方法和结果我们回顾了292名年龄≥ 65岁的受试者的病历，他们因临床心力衰竭住院，属于康涅狄格州纽黑文市老年人流行病学研究的既定人群队列，这是一项纵向的、以社区为基础的老龄化研究，包括对心理社会支持的综合评估。在未校正的分析中，缺乏情感支持与1年内致死性和非致死性心血管结局风险显著相关[比值比，2.4; 95%可信区间，1.1 ~ 4.9]。在调整人口统计学因素、临床严重程度、合并症和功能状态、社会关系和工具支持后，缺乏情感支持仍然与显著较高的风险相关（比值比，3.2; 95%置信区间，1.4至7.8）。情感支持和性别之间的相互作用的测试是显着的（P= 0.01）。在完全校正的模型中，女性的比值比为8.2（95%置信区间，2.5至27.2），而男性为1.0（95%置信区间，0.3至3.3）。结论：在因临床心力衰竭住院的老年患者中，入院前测量的情感支持的缺乏是入院后一年内致命性和非致命性心血管事件发生的一个强有力的独立预测因素。在这一组中，该协会仅限于妇女。
BACKGROUND Several studies have indicated that a variety of social relationships are important predictors of morbidity and mortality in patients with coronary artery disease, but little attention has been focused on the prognostic importance of these factors in the growing population of elderly patients with heart failure. To address this issue, we sought to determine whether emotional support is associated with fatal and nonfatal cardiovascular events in elderly patients hospitalized with heart failure. METHODS AND RESULTS We reviewed the medical records of 292 subjects aged > or =65 years who were hospitalized with clinical heart failure and were part of the New Haven, Conn, cohort of the Established Population for the Epidemiologic Study of the Elderly, a longitudinal, community-based study of aging that included a comprehensive assessment of psychosocial support. In the unadjusted analysis, lack of emotional support was significantly associated with the 1-year risk of fatal and nonfatal cardiovascular outcomes [odds ratio, 2.4; 95% confidence interval, 1.1 to 4.9]. After adjustment for demographic factors, clinical severity, comorbidity and functional status, social ties, and instrumental support, the absence of emotional support remained associated with a significantly higher risk (odds ratio, 3.2; 95% confidence interval, 1.4 to 7.8). The test for interaction between emotional support and sex was significant (P=.01). In the fully adjusted model, the odds ratio for women was 8.2 (95% confidence interval, 2.5 to 27.2) compared with 1.0 (95% confidence interval, 0.3 to 3.3) for men. CONCLUSIONS Among elderly patients hospitalized with clinical heart failure, the absence of emotional support, measured before admission, is a strong, independent predictor of the occurrence of fatal and nonfatal cardiovascular events in the year after admission. In this cohort, the association is restricted to women.