Biostatistics and Data Management Core, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii (GXZ)
Departments of Medicine (Cardiology) (PBP, DLB)
Med Decis Making. 2013 May;33(4):502-9. doi: 10.1177/0272989X13475717. Epub 2013 Feb 13.
The Institute of Medicine has called for a new health care paradigm that integrates patient values into discussions of the risks and benefits of treatment. Although cardiovascular disease (CVD) affects one-third of Americans, little is known about how adults regard the potential harms or complications of treatment.
We sought to determine the preferences of community-dwelling adults for 15 potential harms or complications resulting from treatment of CVD.
In a telephone survey, adults older than 18 years residing on Long Island, New York, were asked to score the preferences for 15 potential harms or complications of treatment of CVD on a scale from 0 to 100. All statistical analyses were based on nonparametric methods. Multivariable general linear model analyses were performed to identify demographic factors associated with the score assigned for each adverse outcome.
The 807 individuals surveyed generated 723 unique sequences of scores for the 15 outcomes. The ranking of scores from least to most acceptable was stroke, major myocardial infarction (MI), cognitive dysfunction, renal failure, death, prolonged ventilator support, heart failure, angina, sternal wound infection, major bleeding, reoperation, prolonged recovery in a nursing home, cardiac readmission, minor MI, and percutaneous coronary intervention. Demographic factors accounted for less than 7% of the observed variation in the score attributed to each outcome.
Individual community-dwelling adults living on Long Island, New York, assign unique values to their preferences for potential harms encountered following treatment of CVD. Thus, risk-benefit discussions and treatment decisions regarding CVD should be harmonized to the value system of each individual.
美国国家医学研究院呼吁建立一种新的医疗保健模式，将患者的价值观纳入治疗风险和益处的讨论中。尽管心血管疾病（CVD）影响了三分之一的美国人，但对于成年人如何看待治疗的潜在危害或并发症知之甚少。
我们旨在确定社区居住的成年人对 CVD 治疗可能产生的 15 种潜在危害或并发症的偏好。
在一项电话调查中，要求居住在纽约长岛的 18 岁以上成年人在 0 到 100 的评分范围内对 CVD 治疗的 15 种潜在危害或并发症的偏好进行评分。所有统计分析均基于非参数方法。采用多变量一般线性模型分析来确定与每种不良结局评分相关的人口统计学因素。
接受调查的 807 人共生成了 15 种不良结局的 723 个独特评分序列。从最不可接受到最可接受的评分排名是中风、大面积心肌梗死（MI）、认知功能障碍、肾衰竭、死亡、延长呼吸机支持、心力衰竭、心绞痛、胸骨伤口感染、大出血、再次手术、在疗养院延长康复、心脏再入院、轻度 MI 和经皮冠状动脉介入治疗。人口统计学因素仅占每个结局评分归因于每个结局的观察变异的 7%以下。
生活在纽约长岛的社区居民个体对 CVD 治疗后可能遇到的潜在危害赋予了独特的价值。因此，CVD 的风险-效益讨论和治疗决策应与每个人的价值体系相协调。
