Informing Clinical Practice Guideline Development and Implementation: Prevalence of Coexisting Conditions Among Adults with Coronary Heart Disease
Informing Clinical Practice Guideline Development and Implementation: Prevalence of Coexisting Conditions Among Adults with Coronary Heart Disease
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DOI：
10.1111/j.1532-5415.2011.03391.x
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发表时间：
2011-05-01
影响因子：
6.3
通讯作者：
Weiss, Carlos O.
中科院分区：
文献类型：
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作者：
Boyd, Cynthia M.;Leff, Bruce;Weiss, Carlos O.
目的：描述影响成人冠心病 (CHD) 临床决策的共存疾病的患病率。设计：横断面。背景：1999 年至 2004 年全国健康和营养检查调查。参与者：8654 名 45 岁及以上的人； 1,259 名 CHD 患者。测量：与临床决策和实施 CHD 治疗相关的共存病症涉及三个领域：慢性病、自我报告和基于实验室的临床测量，以及自我报告和观察到的功能的健康状况因素。根据性别和年龄估计患病率，检查相互排斥的模式，并对患有 CHD 的参与者去年重复住院的比值比 (OR) 以及每种复杂模式与单独 CHD 的比值比 (OR) 进行建模。 结果：CHD 受试者中合并慢性疾病的患病率为关节炎 56.7%，充血性心力衰竭 29.0%，慢性下呼吸道疾病 25.5%，糖尿病 24.8%糖尿病、中风的比例为 13.8%。增加冠心病临床决策复杂性的临床因素包括使用四种以上药物（54.5%）、尿失禁（48.6%）、头晕或跌倒（34.8%）、肾小球滤过率低（24.4%）、贫血（10.1%）、谷丙转氨酶高（5.9%）、使用华法林（10.2%）以及健康状况因素认知障碍（29.9%）、行动困难（40.4%）、经常精神困扰（14.3%）、视力障碍（16.7%）和听力障碍（17.9%）。几种合并症模式与高住院几率相关。 结论：在制定试验和指南时应考虑可能改变 CHD 治疗效果或与 CHD 治疗相互作用、影响 CHD 治疗可行性或改变患者医疗保健优先事项的共存病症，以便更好地为现实世界的临床决策提供信息。 J Am Geriatr Soc 59：797-805，2011。
OBJECTIVES: To describe the prevalence of coexisting conditions that affect clinical decision-making in adults with coronary heart disease (CHD).DESIGN: Cross-sectional.SETTING: National Health and Nutrition Examination Survey, 1999 to 2004.PARTICIPANTS: Eight thousand six hundred fifty-four people aged 45 and older; 1,259 with CHD.MEASUREMENTS: Coexisting conditions relevant to clinical decision-making and implementing therapy for CHD across three domains: chronic diseases, self-reported and laboratory-based clinical measures, and health status factors of self-reported and observed function. Prevalence was estimated according to sex and age, mutually exclusive patterns were examined, and the odds ratios (OR) of having incurred repeated hospitalization in the last year of participants with CHD and each complexity pattern versus CHD alone were modeled.RESULTS: The prevalence of comorbid chronic diseases in subjects with CHD was 56.7% for arthritis, 29.0% for congestive heart failure, 25.5% for chronic lower respiratory tract disease, 24.8% for diabetes mellitus, and 13.8% for stroke. Clinical factors adding to complexity of clinical decision-making for CHD were use of more than four medications (54.5%), urinary incontinence (48.6%), dizziness or falls (34.8%), low glomerular filtration rate (24.4%), anemia (10.1%), high alanine aminotransferase (5.9%), use of warfarin (10.2%), and health status factors were cognitive impairment (29.9%), mobility difficulty (40.4%), frequent mental distress (14.3%), visual impairment (16.7%), and hearing impairment (17.9%). Several comorbidity patterns were associated with high odds of hospitalization.CONCLUSION: Coexisting conditions that may modify the effectiveness of or interact with CHD therapies, influence the feasibility of CHD therapies, or alter patients' priorities concerning their health care should be considered in the development of trials and guidelines to better inform real-world clinical decision-making. J Am Geriatr Soc 59:797-805, 2011.