Dupre Matthew E, Nelson Alicia, Lynch Scott M, Granger Bradi B, Xu Hanzhang, Churchill Erik, Willis Janese M, Curtis Lesley H, Peterson Eric D
Duke Clinical Research Institute, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina; Department of Sociology, Duke University, Durham, North Carolina.
Department of Community and Family Medicine, Duke University, Durham, North Carolina.
Am J Med Sci. 2017 Dec;354(6):565-572. doi: 10.1016/j.amjms.2017.07.011. Epub 2017 Jul 25.
Recent studies have drawn attention to nonclinical factors to better understand disparities in the development, treatment and prognosis of patients with cardiovascular disease. However, there has been limited research describing the nonclinical characteristics of patients hospitalized for cardiovascular care.
Data for this study come from 520 patients admitted to the Duke Heart Center from January 1, 2015 through January 10, 2017. Electronic medical records and a standardized survey administered before discharge were used to ascertain detailed information on patients' demographic (age, sex, race, marital status and living arrangement), socioeconomic (education, employment and health insurance), psychosocial (health literacy, health self-efficacy, social support, stress and depressive symptoms) and behavioral (smoking, drinking and medication adherence) attributes.
Study participants were of a median age of 65 years, predominantly male (61.4%), non-Hispanic white (67.1%), hospitalized for 5.11 days and comparable to all patients admitted during this period. Results from the survey showed significant heterogeneity among patients in their demographic, socioeconomic and behavioral characteristics. We also found that the patients' levels of psychosocial risks and resources were significantly associated with many of these nonclinical characteristics. Patients who were older, women, nonwhite and unmarried had generally lower levels of health literacy, self-efficacy and social support, and higher levels of stress and depressive symptoms than their counterparts.
Patients hospitalized with cardiovascular disease have diverse nonclinical profiles that have important implications for targeting interventions. A better understanding of these characteristics will enhance the personalized delivery of care and improve outcomes in vulnerable patient groups.
最近的研究已将注意力转向非临床因素，以便更好地理解心血管疾病患者在疾病发展、治疗和预后方面的差异。然而，关于因心血管疾病住院患者的非临床特征的研究却很有限。
本研究的数据来自2015年1月1日至2017年1月10日入住杜克心脏中心的520名患者。电子病历和出院前进行的标准化调查被用于确定患者的人口统计学特征（年龄、性别、种族、婚姻状况和居住安排）、社会经济特征（教育程度、就业情况和医疗保险）、心理社会特征（健康素养、健康自我效能感、社会支持、压力和抑郁症状）以及行为特征（吸烟、饮酒和药物依从性）的详细信息。
研究参与者的年龄中位数为65岁，男性占主导（61.4%），非西班牙裔白人占67.1%，住院时间为5.11天，与该时期所有入院患者情况相当。调查结果显示，患者在人口统计学、社会经济和行为特征方面存在显著差异。我们还发现，患者的心理社会风险和资源水平与许多这些非临床特征显著相关。年龄较大、女性、非白人以及未婚患者的健康素养、自我效能感和社会支持水平普遍低于同龄人，压力和抑郁症状水平则高于同龄人。
因心血管疾病住院的患者具有多样的非临床特征，这些特征对干预措施的针对性具有重要意义。更好地了解这些特征将加强个性化护理服务，并改善脆弱患者群体的治疗效果。
