Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; John Ware Research Group, Watertown, Massachusetts.
Am J Cardiol. 2018 Oct 1;122(7):1121-1127. doi: 10.1016/j.amjcard.2018.06.043. Epub 2018 Aug 11.
Little is known about how barriers to healthcare access affect health-related quality of life (HRQOL) after an acute coronary syndrome (ACS). In a large cohort of ACS survivors from 6 medical centers in Massachusetts and Georgia enrolled from 2011 to 2013, patients were classified as having any financial barriers, no usual source of care (USOC), or transportation barriers to healthcare based on their questionnaire survey responses. The principal study outcomes included clinically meaningful declines in generic physical and mental HRQOL and in disease-specific HRQOL from 1 to 6 months posthospital discharge. Adjusted relative risks (aRRs) for declines in HRQOL were calculated using Poisson regression models, controlling for several sociodemographic and clinical factors of prognostic importance. In 1,053 ACS survivors, 29.0% had a financial barrier, 14.2% had no USOC, and 8.7% had a transportation barrier. Patients with a financial barrier had greater risks of experiencing a decline in generic physical (aRR 1.48, 95% confidence interval [CI] 1.17, 1.86) and mental (aRR 1.36, 95% CI 1.07, 1.75) HRQOL at 6 months. Patients with 2 or more access barriers had greater risks of decline in generic physical (aRR 1.53, 95% CI 1.20, 1.93) and mental (aRR 1.50, 95% CI 1.17, 1.93) HRQOL compared with those without any healthcare barriers. There was a modest association between lacking a USOC and experiencing a decline in disease-specific HRQOL (aRR 1.46, 95% CI 0.96, 2.22). Financial and other barriers to healthcare access may be associated with clinically meaningful declines in HRQOL after hospital discharge for an ACS.
对于急性冠状动脉综合征（ACS）后医疗保健获取障碍如何影响健康相关生活质量（HRQOL），人们知之甚少。在 2011 年至 2013 年期间，从马萨诸塞州和佐治亚州的 6 家医疗中心招募的大量 ACS 幸存者中，根据他们的问卷调查回复，将患者分为存在任何财务障碍、没有常规医疗服务来源（USOC）或医疗保健交通障碍。主要研究结果包括从出院后 1 个月到 6 个月期间，通用身体和心理健康 HRQOL 以及特定疾病 HRQOL 出现有临床意义的下降。使用泊松回归模型计算 HRQOL 下降的调整相对风险（aRR），并控制了几个具有预后重要性的社会人口统计学和临床因素。在 1053 名 ACS 幸存者中，有 29.0%存在财务障碍，14.2%没有 USOC，8.7%存在交通障碍。有财务障碍的患者发生通用身体（aRR 1.48，95%置信区间[CI] 1.17，1.86）和精神（aRR 1.36，95%CI 1.07，1.75）HRQOL 下降的风险更高在 6 个月时。有 2 个或更多获取障碍的患者发生通用身体（aRR 1.53，95%CI 1.20，1.93）和精神（aRR 1.50，95%CI 1.17，1.93）HRQOL 下降的风险更高与没有任何医疗保健障碍的患者相比。缺乏 USOC 与特定疾病 HRQOL 下降之间存在适度关联（aRR 1.46，95%CI 0.96，2.22）。医疗保健获取的财务和其他障碍可能与 ACS 出院后 HRQOL 出现有临床意义的下降有关。
