基层老年慢性病患者心血管疾病综合发生风险的影响因素研究

A Study on the Factors Influencing the Comprehensive Risk of Cardiovascular Disease in Elderly Patients with Chronic Disease in Primary Care

背景心血管疾病是造成我国居民死亡和疾病负担的首要病因,防控形势严峻。心血管疾病风险影响因素管理是预防心血管疾病的重要基础。但目前国内外应用单导联可穿戴心电设备针对基层老年慢性病患者心血管疾病发生风险的影响因素调查研究较少,且在既往研究中也未以整体观对患者包含不同数量风险的变量重要性进行排序。目的分析基层管理的65岁以上老年慢性病患者心血管疾病综合发生风险的影响因素,为基层心血管疾病综合防控提供客观依据及帮助。方法选取2021年12月—2022年9月宁夏回族自治区26家基层医疗卫生机构的3039例65岁以上+高血压、糖尿病、冠心病其中至少1种慢性病的患者为研究对象。依据72 h心电图分析结果划分为正常组632例、风险组2407例。分析两组患者基本资料,确定最佳λ值,绘制模型,采用LASSO回归和多因素Logistic回归分析探讨老年慢性病患者心血管疾病综合风险影响因素;并对影响心血管疾病综合风险及包含不同数量风险的变量排序。结果两组患者年龄、性别、BMI、教育程度、职业、城乡分布、吸烟、运动、冠心病+糖尿病、高血压+冠心病及糖尿病比较,差异均有统计学意义(P<0.05);最佳λ值为0.01568531。LASSO回归和多因素Logistic回归模型分析显示年龄、BMI、城乡分布、吸烟、高血压+冠心病+糖尿病是心血管疾病综合风险的影响因素(P<0.05)。受试者工作特征曲线下面积(AUC)=0.650(95%CI=0.627~0.673,P<0.001)。影响综合风险及不同数量风险种类变量排序前五位的分别为:年龄、BMI、城乡分布、饮茶、运动;年龄、高血压+冠心病、性别、城乡分布、吸烟;年龄、高血压+冠心病、性别、BMI、城乡分布;糖尿病+冠心病、年龄、高血压+冠心病、高血压+冠心病+糖尿病、高血压+糖尿病。结论年龄、BMI、城乡分布、吸烟、高血压合并冠心病及糖尿病是65岁以上+慢性病患者发生心血管疾病风险的影响因素。除年龄外,BMI及生活习惯对心血管疾病综合风险的发生影响较为重要,随着+风险种类数量的增多,慢性病尤其慢性病共病的影响增强。基层医护团队应以单导联可穿戴设备为载体定期对老年慢性病患者进行心血管疾病综合发生风险管理,其不但可高效、低成本的实现心血管疾病发生风险的一级、二级预防及健康管理,并可加速基层医疗服务应加快从不连贯的诊疗服务向全程健康管理的转变。

Background Cardiovascular disease is the primary cause of death and Disease burden of Chinese residents,and the situation of prevention and control is grim.Management of risk factors for cardiovascular disease is an important foundation for preventing cardiovascular disease.However,there is currently limited research on the influencing risk factors of cardiovascular disease risk in elderly patients with chronic disease in primary care using single lead wearable electrocardiogram devices both domestically and internationally,and previous studies have not ranked the importance of variables containing different quantities of risk in patients from a holistic perspective.Objective The aim of this study is to analyze the influencing factors of the comprehensive risk of cardiovascular disease in elderly patients with chronic disease aged 65 and above in primary care in Ningxia,and to provide objective basis and assistance for the comprehensive prevention and control of cardiovascular disease in primary care.Methods From December 2021 to September 2022,totally 3039 patients over 65 years old with hypertension,diabetes and coronary heart disease,including at least one chronic disease,from 26 primary care health center in Ningxia were selected as the research subjects.According to the analysis of the 72 hour electrocardiogram,there were 632 cases in the normal group and 2407 cases in the risk group.Analyze the basic information of two groups of patients to determine the bestλValue,draw a model,and use LASSO regression and multivariate Logistic regression to analyze the comprehensive risk factors of cardiovascular disease in elderly patients with chronic diseases;and rank the variables that affect the overall risk of cardiovascular disease and include different numbers of risks among patients.Results The differences in age,gender,BMI,education level,occupation,urban-rural distribution,smoking,exercise,coronary heart disease combined with diabetes,hypertension combined with coronary heart disease and diabetes between the two groups of patients were statistically significant(P<0.05);optimumλvalue was 0.01568531.LASSO regression and multivariate logistic regression model analysis showed that age,BMI,urban-rural distribution,smoking Hypertension combined with coronary heart disease and diabetes is a influencing factor for cardiovascular disease(P<0.05).Auc was 0.650(95%CI=0.627-0.673,P<0.001)The top five variables that affect comprehensive risk and different types of risk are age,BMI,urban-rural distribution,tea drinking,and exercise;Age,hypertension combined with coronary heart disease,gender,urban-rural distribution,smoking;Age,hypertension combined with coronary heart disease,gender,BMI,urban-rural distribution;Diabetes combined with coronary heart disease,age,hypertension combined with coronary heart disease,hypertension combined with coronary heart disease and diabetes,hypertension combined with diabetes.Conclusion Age,BMI,urban and rural distribution,smoking,hypertension with coronary heart disease and diabetes are the influencing factors of cardiovascular disease risk in patients over 65 years old with chronic diseases.In addition to age,BMI and lifestyle habits have a significant impact on the overall risk of cardiovascular disease.As the number of comorbidities increases,the impact of chronic diseases,especially chronic disease comorbidities,increases.Primary care medical teams should regularly conduct comprehensive CVD risk management for elderly patients with multiple chronic diseases using single lead wearable devices.This not only enables efficient and low-cost implementation of primary and secondary prevention and health management of CVD risks,but also accelerates the transformation of primary medical services from inconsistent diagnosis and treatment services to full process health management.