精神障害と心筋梗塞後の心血管手術の使用
B G Druss1, D W Bradford, R A Rosenheck
1Department of Psychiatry, Yale University School of Medicine, VA Northeast Program Evaluation Center, New Haven, Conn, USA. benjamin.druss@yale.edu
JAMA
|February 5, 2000
まとめ
精神障害のある患者は,急性心筋梗塞の後,心経導管化,皮膚経光冠動脈血管形成手術 (PTCA),または冠動脈バイパス移植 (CABG) を受ける可能性が著しく低かった.
科学分野:
- 心臓病学 心臓病学
- 精神科医は精神病を患っている.
- 医療サービス 研究 医療サービス
背景:
- 既存の研究は,心臓血管手術の頻度における人種と性差異を示しています.
- 併発性精神疾患は,臨床的,社会経済的,患者および提供者の要因により,心血管手術率の低下に関連している可能性があります.
研究 の 目的:
- 併発性精神疾患の患者が,急性心筋梗塞の後に心筋カテーテリゼーションまたは再血管化を受ける可能性が低いかどうかを判断する.
主な方法:
- リトロスペクティブコホート研究では,医療記録と行政記録から得られたデータを分析した.
- この研究では,1994年2月から1995年7月にかけて急性心筋梗塞で入院した65歳以上の患者113,653人を対象とした.
- 併発性精神障害には,統合失調症,重症感情障害,薬物乱用/依存症,その他の精神障害が含まれていた.
主要な成果:
- 精神障害のある患者は,皮膚経由の透光冠動脈血管形成術 (PTCA) または冠動脈バイパス移植 (CABG) を受ける可能性が著しく低い.
- 共同変数を調整した結果,精神障害のある個人は,心臓キャセテリゼーションを受けない個人に比べて41%から78%の確率で心臓キャセテリゼーションを受けていた.
- 精神障害のある患者とない患者の間で30日間の死亡率において有意な差は認められなかった.
結論:
- 併発性精神障害は,冠動脈再血管化処置の割合がかなり低いと関連しています.
- これらの格差に寄与する患者および医療提供者の要因,および医療の質と結果への影響を探るため,さらなる研究が必要である.
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