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连续性护理对初诊高血压患者心血管疾病风险的影响。

Impact of continuity of care on cardiovascular disease risk among newly-diagnosed hypertension patients.

机构信息

Department of Biomedical Sciences, College of Medicine, Seoul National University Graduate School, Seoul, South Korea.

Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, USA.

出版信息

Sci Rep. 2020 Nov 17;10(1):19991. doi: 10.1038/s41598-020-77131-w.

Abstract

Several previous studies have noted benefits of maintaining continuity of care (COC), including improved patient compliance, decreased health care cost, and decreased incidence of hospitalization. However, the association of COC in hypertension patients with subsequent cardiovascular disease (CVD) risk is yet unclear. Therefore, we aimed to investigate the impact of COC on CVD risk among newly-diagnosed hypertension patients. We conducted a cohort with a study population consisted of 244,187 newly-diagnosed hypertension patients in 2004 from the Korean National Health Insurance Service database. The participants were then divided into approximate quartiles of COC index, and followed from 1 January 2007 until 31 December 2017. Cox proportional hazards models were used to evaluate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD risk according to quartiles. Compared to patients within the lowest quartile of COC index, those within the highest quartile of COC index had reduced risk for CVD (aHR 0.76, 95% confidence interval; CI 0.73-0.79), CHD (aHR 0.66, 95% CI 0.62-0.69) and stroke (aHR 0.84, 95% CI 0.80-0.88). COC among hypertension patients was associated with improved medication compliance and reduced risk of stroke and CVD. The importance of maintaining COC should be emphasized to reduce the risk of CVD among hypertension patients.

摘要

先前的几项研究指出了保持连续性医疗照护(COC)的益处,包括提高患者的依从性、降低医疗保健成本和减少住院率。然而,COC 与高血压患者随后发生心血管疾病(CVD)风险之间的关联尚不清楚。因此,我们旨在研究 COC 对新诊断高血压患者 CVD 风险的影响。我们进行了一项队列研究,研究人群为 2004 年韩国国家健康保险服务数据库中 244187 名新诊断的高血压患者。然后,将参与者按照 COC 指数的近似四分位数进行分组,并从 2007 年 1 月 1 日随访至 2017 年 12 月 31 日。使用 Cox 比例风险模型评估 CVD 风险的调整后的危险比(aHR)和 95%置信区间(CI)按四分位数。与 COC 指数最低四分位数的患者相比,COC 指数最高四分位数的患者 CVD(aHR0.76,95%CI0.73-0.79)、冠心病(aHR0.66,95%CI0.62-0.69)和中风(aHR0.84,95%CI0.80-0.88)的风险降低。高血压患者的 COC 与改善药物依从性以及降低中风和 CVD 风险相关。应强调维持 COC 的重要性,以降低高血压患者的 CVD 风险。

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