Krumholz H M, Butler J, Miller J, Vaccarino V, Williams C S, Mendes de Leon C F, Seeman T E, Kasl S V, Berkman L F
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06520-8025, USA.
Circulation. 1998 Mar 17;97(10):958-64. doi: 10.1161/01.cir.97.10.958.
Several studies have indicated that a variety of social relationships are important predictors of morbidity and mortality in patients with coronary artery disease, but little attention has been focused on the prognostic importance of these factors in the growing population of elderly patients with heart failure. To address this issue, we sought to determine whether emotional support is associated with fatal and nonfatal cardiovascular events in elderly patients hospitalized with heart failure.
We reviewed the medical records of 292 subjects aged > or =65 years who were hospitalized with clinical heart failure and were part of the New Haven, Conn, cohort of the Established Population for the Epidemiologic Study of the Elderly, a longitudinal, community-based study of aging that included a comprehensive assessment of psychosocial support. In the unadjusted analysis, lack of emotional support was significantly associated with the 1-year risk of fatal and nonfatal cardiovascular outcomes [odds ratio, 2.4; 95% confidence interval, 1.1 to 4.9]. After adjustment for demographic factors, clinical severity, comorbidity and functional status, social ties, and instrumental support, the absence of emotional support remained associated with a significantly higher risk (odds ratio, 3.2; 95% confidence interval, 1.4 to 7.8). The test for interaction between emotional support and sex was significant (P=.01). In the fully adjusted model, the odds ratio for women was 8.2 (95% confidence interval, 2.5 to 27.2) compared with 1.0 (95% confidence interval, 0.3 to 3.3) for men.
Among elderly patients hospitalized with clinical heart failure, the absence of emotional support, measured before admission, is a strong, independent predictor of the occurrence of fatal and nonfatal cardiovascular events in the year after admission. In this cohort, the association is restricted to women.
多项研究表明，多种社会关系是冠状动脉疾病患者发病和死亡的重要预测因素，但在日益增多的老年心力衰竭患者中，这些因素的预后重要性却很少受到关注。为解决这一问题，我们试图确定情感支持是否与因心力衰竭住院的老年患者的致命和非致命心血管事件相关。
我们回顾了292名年龄≥65岁、因临床心力衰竭住院的受试者的病历，这些受试者是康涅狄格州纽黑文市老年流行病学研究既定人群队列的一部分，这是一项基于社区的纵向衰老研究，其中包括对心理社会支持的全面评估。在未经调整的分析中，缺乏情感支持与1年内致命和非致命心血管结局的风险显著相关[优势比，2.4；95%置信区间，1.1至4.9]。在对人口统计学因素、临床严重程度、合并症和功能状态、社会关系以及工具性支持进行调整后，缺乏情感支持仍然与显著更高的风险相关（优势比，3.2；95%置信区间，1.4至7.8）。情感支持与性别之间的交互作用检验具有显著性（P = 0.01）。在完全调整模型中，女性的优势比为8.2（95%置信区间，2.5至27.2），而男性为1.0（95%置信区间，0.3至3.3）。
在因临床心力衰竭住院的老年患者中，入院前测量的缺乏情感支持是入院后一年内发生致命和非致命心血管事件的强有力独立预测因素。在这个队列中，这种关联仅限于女性。
