Impact of Partner Bereavement on Quality of Cardiovascular Disease Management

• Published in: Circulation (New York, N.Y.) N.Y.), 2013-12, Vol.128 (25), p.2745-2753
• Main Authors: Shah, Sunil M, Carey, Iain M, Harris, Tess, DeWilde, Stephen, Victor, Christina R, Cook, Derek G
• Format: Article
• Language: English
• Subjects: Aged; Antihypertensive Agents - therapeutic use; Bereavement; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - mortality; Case-Control Studies; Disease Management; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Humans; Hypolipidemic Agents - therapeutic use; Male; Medical sciences; Patient Compliance - psychology; Platelet Aggregation Inhibitors - therapeutic use; Quality of Health Care; Risk Factors; Spouses - psychology
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.113.004122

BACKGROUND—Bereavement is a period of increased risk of cardiovascular death. There is limited understanding of the potential contribution of quality of cardiovascular disease management to this increased risk. METHODS AND RESULTS—In a UK primary-care database, 12 722 older individuals with preexisting cardiovascular disease (coronary heart disease, hypertension, diabetes mellitus, stroke) and a partner bereavement were matched with a non-bereaved control group (n=33 911). We examined key routine annual process measures of care in the year before and after bereavement and cardiovascular medication prescribing (lipid-lowering, antiplatelet, renin–angiotensin system drugs). Odds ratios for change after bereavement compared with the change in non-bereaved matched controls are presented. In the bereaved, uptake of all annual measures was lower in the year before bereavement, with improvement in the year after, whereas in the controls, uptake was relatively stable. The odds ratio for change was 1.30 (95% confidence interval, 1.15–1.46) for cholesterol measurement and 1.40 (95% confidence interval, 1.22–1.61) for blood pressure measurement. For all medication, there was a transient fall in prescribing in the peri-bereavement period lasting until about 3 months after bereavement. The odds ratio for at least 80% prescription coverage in the 30 days after bereavement was 0.80 (95% confidence interval, 0.73–0.88) for lipid-lowering medication and 0.82 (95% confidence interval, 0.74–0.91) for antiplatelet medication compared with the change in non-bereaved individuals. CONCLUSIONS—Lower uptake of key cardiovascular care measures in the year before bereavement and reduced medication coverage after bereavement may contribute to increased cardiovascular risk. Clinicians need to ensure that quality of cardiovascular care is maintained in the pre- and post-bereavement periods.