心血管风险评估方法产生不平等的风险预测:一项针对精神病二级护理门诊患者的大型横截面研究
Davy Quadackers1,2, Edith Liemburg3, Fionneke Bos3,4
1Mental Health Services Drenthe, P.O. box 30007, 9400 RA, Assen, The Netherlands. davy.quadackers@ggzdrenthe.nl.
BMC psychiatry
|July 24, 2023
概括
心血管疾病风险评估方法在精神病患者中表现不佳,可能会推迟治疗. 对这一群体进行心血管风险 (CVR) 模型的重新校准和统一实施至关重要.
科学领域:
- 心脏病学 心脏病学
- 精神病学是一个精神病学.
- 公共卫生 公共卫生
背景情况:
- 患有精神疾病的患者面临更高的心血管疾病 (CVD) 风险.
- 准确的心血管风险 (CVR) 评估对于早期检测和治疗这一群体至关重要.
- 目前的CVR评估方法在精神病学家 (代谢综合征概念) 和全科医生 (绝对风险模型) 之间有所不同,专门的PRIMROSE模型也存在.
研究的目的:
- 为了比较不同CVR评估方法在精神病室门诊患者的一致性.
- 评估来自各种CVR评估工具的风险预测差异.
主要方法:
- 使用了精神病室门诊患者的体质数据 (PHAMOUS和MOPHAR数据库).
- 包括40至70岁没有之前或目前心血管疾病或糖尿病的患者.
- 评估CVR分类评估之间的一致性 (代谢综合征状态与二进制风险类别),代谢综合征标准与绝对风险之间的相关性,以及绝对风险之间的一致性.
主要成果:
- 在分类的CVR评估中发现了系统的不一致 (p < 0.036).
- 在代谢综合征状态和二进制弗雷明汉姆评估之间观察到公平协议 (κ = 0.230.28).
- 在代谢综合征标准和Framingham/PRIMROSE脂质评分之间存在中等强度的相关性 (τ = 0.250.34).
- 只有连续的PRIMROSE表和脂质结局显示了中度一致 (ρ = 0.91).
结论:
- 在CVR评估方法的差异导致不平等的风险预测和潜在的治疗开始差异在精神病患者.
- 鉴于增加的健康风险,CVR模型需要从青春期开始对精神病患者进行重新校准.
- 建议医疗保健提供者统一实施标准化CVR评估工具.
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