Columbia University Medical Center, New York-Presbyterian Hospital, New York, USA.
Am J Cardiol. 2012 Jan 1;109(1):135-9. doi: 10.1016/j.amjcard.2011.07.072. Epub 2011 Sep 29.
Caregivers might represent an opportunity to improve cardiovascular disease outcomes, but prospective data are limited. We studied 3,188 consecutive patients (41% minority, 39% women) admitted to a university hospital medical cardiovascular service to evaluate the association between having a caregiver and rehospitalization/death at 1 year. The clinical outcomes at 1 year were documented using a hospital-based clinical information system supplemented by a standardized questionnaire. Co-morbidities were documented by hospital electronic record review. At baseline, 13% (n = 417) of the patients had a paid caregiver and 25% (n = 789) had only an informal caregiver. Having a caregiver was associated with rehospitalization or death at 1 year (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.45 to 1.95), which varied by paid (OR 2.46, 95% CI 1.96 to 3.09) and informal (OR 1.40, 95% CI 1.18 to 1.65) caregiver status. Having a caregiver was significantly (p <0.05) associated with age ≥65 years, racial/ethnic minority, lack of health insurance, medical history of diabetes mellitus or hypertension, a Ghali co-morbidity index >1, chronic obstructive pulmonary disease, or taking ≥9 prescriptions medications. The relation between caregiving and rehospitalization/death at 1 year was attenuated but remained significant after adjustment (paid, OR 1.64, 95% CI 1.26 to 2.12; and informal, OR 1.20, 95% CI 1.00 to 1.44). In conclusion, the risk of rehospitalization/death was significantly greater among cardiac patients with caregivers and was not fully explained by the presence of traditional co-morbidities. Systematic determination of having a caregiver might be a simple method to identify patients at a heightened risk of poor clinical outcomes.
照顾者可能是改善心血管疾病结局的机会，但前瞻性数据有限。我们研究了连续 3188 例（41%为少数族裔，39%为女性）入住大学医院心血管医学服务的患者，以评估有照顾者与 1 年内再住院/死亡的关系。通过医院基于临床信息系统和标准化问卷记录 1 年时的临床结局。通过医院电子病历回顾记录合并症。基线时，13%（n=417）的患者有付费照顾者，25%（n=789）的患者只有非正式照顾者。有照顾者与 1 年内再住院或死亡相关（比值比[OR]1.68，95%置信区间[CI]1.45-1.95），这与付费（OR 2.46，95%CI 1.96-3.09）和非付费（OR 1.40，95%CI 1.18-1.65）照顾者状态有关。有照顾者与年龄≥65 岁、种族/少数民族、缺乏医疗保险、糖尿病或高血压病史、Ghali 合并症指数>1、慢性阻塞性肺疾病或服用≥9 种处方药物显著相关（p<0.05）。调整后（付费，OR 1.64，95%CI 1.26-2.12；和非正式，OR 1.20，95%CI 1.00-1.44），照顾与 1 年内再住院/死亡的关系减弱但仍然显著。总之，有照顾者的心脏患者再住院/死亡的风险显著增加，且不能完全用传统合并症来解释。系统确定是否有照顾者可能是识别临床结局不良风险增加患者的一种简单方法。
