Impact of Partner Bereavement on Quality of Cardiovascular Disease Management
Impact of Partner Bereavement on Quality of Cardiovascular Disease Management
复制标题
伴侣丧亲对心血管疾病管理质量的影响
作者：
Sunil M. Shah;I. Carey;T. Harris;S. DeWilde;C. Victor;D. Cook
背景-丧亲期是心血管死亡风险增加的时期。对于心血管疾病管理质量对这种风险增加的潜在贡献的理解有限。方法和结果-在英国初级保健数据库，12 722老年人与既存的心血管疾病（冠心病，高血压，糖尿病，中风）和伴侣丧亲匹配非丧亲对照组（n=33 911）。我们检查了在丧亲之痛和心血管药物处方（降脂、抗血小板、肾素-血管紧张素系统药物）前后一年的关键常规年度护理过程措施。与非丧亲匹配对照组相比，丧亲后变化的比值比。在丧亲之痛，摄取的所有年度措施是较低的前一年丧亲之痛，改善后的一年，而在控制，摄取相对稳定。对于胆固醇测量，变化的比值比为1.30（95%置信区间，1.15-1.46），对于血压测量，变化的比值比为1.40（95%置信区间，1.22-1.61）。对于所有药物，在丧亲期间的处方量短暂下降，持续到丧亲后约3个月。与非丧亲个体相比，丧亲后30天内至少80%处方覆盖率的比值比为降脂药物0.80（95%置信区间，0.73-0.88），抗血小板药物0.82（95%置信区间，0.74-0.91）。结论：丧亲前一年对关键心血管护理措施的较低吸收和丧亲后药物覆盖率的降低可能导致心血管风险增加。临床医生需要确保心血管护理的质量在丧亲前后保持。
Background— Bereavement is a period of increased risk of cardiovascular death. There is limited understanding of the potential contribution of quality of cardiovascular disease management to this increased risk. Methods and Results— In a UK primary-care database, 12 722 older individuals with preexisting cardiovascular disease (coronary heart disease, hypertension, diabetes mellitus, stroke) and a partner bereavement were matched with a non-bereaved control group (n=33 911). We examined key routine annual process measures of care in the year before and after bereavement and cardiovascular medication prescribing (lipid-lowering, antiplatelet, renin–angiotensin system drugs). Odds ratios for change after bereavement compared with the change in non-bereaved matched controls are presented. In the bereaved, uptake of all annual measures was lower in the year before bereavement, with improvement in the year after, whereas in the controls, uptake was relatively stable. The odds ratio for change was 1.30 (95% confidence interval, 1.15–1.46) for cholesterol measurement and 1.40 (95% confidence interval, 1.22–1.61) for blood pressure measurement. For all medication, there was a transient fall in prescribing in the peri-bereavement period lasting until about 3 months after bereavement. The odds ratio for at least 80% prescription coverage in the 30 days after bereavement was 0.80 (95% confidence interval, 0.73–0.88) for lipid-lowering medication and 0.82 (95% confidence interval, 0.74–0.91) for antiplatelet medication compared with the change in non-bereaved individuals. Conclusions— Lower uptake of key cardiovascular care measures in the year before bereavement and reduced medication coverage after bereavement may contribute to increased cardiovascular risk. Clinicians need to ensure that quality of cardiovascular care is maintained in the pre- and post-bereavement periods.
影响因子：
120.7
作者：
Maciejewski, Paul K.;Zhang, Baohui;Prigerson, Holly G.
通讯作者：
Prigerson, Holly G.
老年冠状动脉疾病患者的重度抑郁和药物依从性。
DOI：
10.1037//0278-6133.14.1.88
发表时间：
1995
期刊：
Health psychology : official journal of the Division of Health Psychology, American Psychological Association
影响因子：
--
作者：
Carney,RM;Freedland,KE;Eisen,SA;Rich,MW;Jaffe,AS
通讯作者：
Jaffe,AS