心血管疾病发病风险感知与客观估算风险的相关性及护理对策

doi:10.3761/j.issn.0254-1769.2023.02.003

摘要/Abstract

摘要：

目的探讨心血管疾病（cardiovascular disease，CVD）发病风险感知与总体风险的关系，为制订针对性干预对策提供依据。方法 2022年3月—7月便利选取杭州市某三级甲等医院的体检人群和来院就诊的糖尿病、高血压患者735例作为调查对象，采用一般资料调查表、CVD总体风险评估工具和CVD风险感知评估工具进行调查，分析不同人口学特征人群CVD绝对风险感知与总体风险值的相关性，比较绝对风险感知与总体风险值的差异。结果共回收有效问卷692份，有效问卷回收率为94.1%。CVD总体风险值为1.0%（0.2%，6.4%），绝对风险感知为2.0（1.0，3.0）。CVD绝对风险感知与总体风险值呈正相关（r_s=0.181，P<0.001）。分层分析显示，40~59岁、低体重或肥胖、少数民族、小学及以下文化程度、单身、吸烟、饮酒、有无糖尿病现病史、有无服用降糖药、有高血压现病史、服用降压药、高胆固醇血症人群中，绝对风险感知与总体风险值无显著相关性（P>0.05）。绝对风险感知分级与总体风险分级比较，差异具有统计学意义（χ²=16.17，P=0.003），风险感知低估率、一致率、高估率分别为30.3%、56.5%、13.2%。结论风险感知低估普遍存在，医护人员应重点关注风险感知与总体风险不一致的人群，并针对个体风险特征制订针对性的干预策略，以改善其风险感知、降低CVD的发生风险。

关键词: 心血管疾病, 风险感知, 预测模型, 相关性, 护理管理研究

Abstract:

Objective To explore the relationship between cardiovascular disease（CVD） risk perception and overall risk，and to provide evidence for formulating targeted intervention strategies. Methods A total of 735 participants including physical examination subjects and patients with diabetes or hypertension from a tertiary Grade A hospital in Hangzhou were recruited from March to July 2022. The general information questionnaire，CVD overall risk assessment model and risk perception assessment tool were used to investigate the correlation between the absolute risk perception and the overall risk value of different demographic characteristics，and to compare the difference between the absolute risk perception and the overall risk. Results A total of 692 valid questionnaires were collected with a recovery rate of 94.1%. The median（P₂₅，P₇₅） of CVD overall risk was 1.0%（0.2%，6.4%），and the median（P₂₅，P₇₅） of absolute risk perception was 2.0 （1.0，3.0）. The absolute risk perception of CVD was positively correlated with the total risk value（r_s=0.181，P<0.001）；stratified analysis showed that there was no significant correlation between risk perception and objective CVD risk among people aged 40~59，with low weight or obesity，ethnic minorities，education level of primary school or below，single，smokers，drinkers，diabetes or not，taking anti-diabetic or not，hypertension，blood pressure medications，and hypercholesterolemia（P>0.05）. There was a significant difference between the absolute risk perception classification and the overall risk classification（χ²=16.17，P=0.003）. The risk underestimation，accurate perception and overestimation rates were 30.3%，56.5% and 13.2%，respectively. Conclusion CVD risk underestimation is common. Medical staff should focus on the characteristic population whose risk perception is inconsistent with the overall risk，and formulate targeted intervention strategies to improve their risk perception and reduce the risk of CVD.

Key words: Cardiovascular Diseases, Risk Perception, Prediction Model, Correlation, Nursing Administration Research

郭芝廷, 陈洁, 郭二菱, 沈国丽, 丁传琦, 黄玉香, 张玉萍, 金静芬. 心血管疾病发病风险感知与客观估算风险的相关性及护理对策[J]. 中华护理杂志, 2023, 58(2): 150-157.

GUO Zhiting, CHEN Jie, GUO Erling, SHEN Guoli, DING Chuanqi, HUANG Yuxiang, ZHANG Yuping, JIN Jingfen. Cardiovascular disease risk perception and overall risk：correlation and solutions[J]. Chinese Journal of Nursing, 2023, 58(2): 150-157.

图/表 3

表1 不同特征调查对象绝对风险感知情况比较（n=692）

Table 1 Classification of cardiovascular disease risk perception of general demographic data of participants（n=692）

表2 不同特征调查对象风险感知和总体风险的相关性分析[M（P25，P75），n=692]

Table 2 Correlation analysis of risk perception and total cardiovascular disease risk among different characteristics of participants[M（P25，P75），n=692]

图1 不同相对风险感知组总体风险值与理想风险值比较注:1.总体风险值;2.理想风险值。

Figure 1 Comparison of total risk and ideal risk among different relative risk perception groups

参考文献 34

[1]	中国心血管健康与疾病报告编写组. 《中国心血管健康与疾病报告2021》概述[J]. 中国心血管病研究, 2022, 20(7):577-596.
	The Writing Committee of the Report on Cardiovascular Health and Diseases in China. Key points of report on cardiovascular health and diseases in China 2021[J]. Chin J Cardiovasc Res, 2022, 20(7):577-596.
[2]	中国心血管病风险评估和管理指南编写联合委员会. 中国心血管病风险评估和管理指南[J]. 中华预防医学杂志, 2019, 53(1):13-35.
	The Joint Task Force for Guideline on the Assessment and Management of Cardiovascular Risk in China. The joint task force for guideline on the assessment and management of cardiovascular risk in China[J]. Chin J Prev Med, 2019, 53(1): 13-35.
[3]	郭芝廷, 毛越, 张玉萍, 等. 心血管疾病发病风险感知评估工具的研究进展[J]. 中华护理杂志, 2022, 57(13):1579-1584. DOI
	Guo ZT, Mao Y, Zhang YP, et al. Research progress of risk perception assessment tools for cardiovascular disease[J]. Chin J Nurs, 2022, 57(13):1579-1584. DOI
[4]	Navar AM, Wang TY, Li S, et al. Patient-perceived versus actual risk of cardiovascular disease and associated willingness to consider and use prevention therapy[J]. Circ Cardiovasc Qual Outcomes, 2021, 14(1):e006548. DOI URL
[5]	Fung V, Graetz I, Reed M, et al. Patient-reported adherence to statin therapy,barriers to adherence,and perceptions of cardiovascular risk[J]. PLoS One, 2018, 13(2):e0191817. DOI URL
[6]	Winter J, Wuppermann A. Do they know what is at risk? Health risk perception among the obese[J]. Health Econ, 2014, 23(5):564-585. DOI PMID
[7]	Alwan H, William J, Viswanathan B, et al. Perception of cardiovascular risk and comparison with actual cardiovascular risk[J]. Eur J Cardiovasc Prev Rehabil, 2009, 16(5):556-561. DOI URL
[8]	Tran DMT. College students’ perception of current and projected 30-year cardiovascular disease risk using cluster analysis with internal validation[J]. J Community Health, 2019, 44(3):500-506. DOI URL
[9]	Won JU, Hong OS, Hwang WJ. Actual cardiovascular disease risk and related factors:a cross-sectional study of Korean blue collar workers employed by small businesses[J]. Workplace Health Saf, 2013, 61(4):163-171.
[10]	Robinson N, Miller A, Wilbur J, et al. Subjective versus objective estimated cardiovascular disease risk and adherence to physical activity in African American women[J]. J Cardiovasc Nurs, 2018, 33(2):111-117. DOI PMID
[11]	de Lima MM Jr, da Silva GR, Jensem Filho SS, et al. Association between perceived lifetime risk of cardiovascular disease and calculated risk in a male population in Brazil[J]. Vasc Health Risk Manag, 2016, 12:279-286. DOI PMID
[12]	Wu Z, Li ZR, Dai YQ, et al. Relationship between risk perception and lifestyle in ischemic stroke patients with H-type hypertension[J]. Ann Palliat Med, 2020, 9(6):3731-3741. DOI PMID
[13]	Homko CJ, Zamora L, Santamore WP, et al. Gender differences in cardiovascular risk factors and risk perception among individuals with diabetes[J]. Diabetes Educ, 2010, 36(3):483-488. DOI PMID
[14]	Cioe PA, Crawford SL, Stein MD. Cardiovascular risk-factor knowledge and risk perception among HIV-infected adults[J]. J Assoc Nurses AIDS Care, 2014, 25(1):60-69. DOI PMID
[15]	中国肥胖问题工作组数据汇总分析协作组. 我国成人体重指数和腰围对相关疾病危险因素异常的预测价值:适宜体重指数和腰围切点的研究[J]. 中华流行病学杂志, 2002, 23(1):5-10.
	Cooperative Meta-analysis Group of China Obesity Task Force. Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population[J]. Chin J Epidemiol, 2002, 23(1):5-10.
[16]	国家卫生和计划生育委员会. 中华人民共和国卫生行业标准(WS/T428-2013)成人体重判定[S]. 北京: 中国标准出版社, 2013.
	National Health and Family Planning Commission of the People’s Republic of China. Health Industry Standard of the People’s Republic of China(WS/T428-2013) adult weight determination[S]. Beijing: Standards Press of China, 2013.
[17]	中国成人血脂异常防治指南修订联合委员会. 中国成人血脂异常防治指南(2016年修订版)[J]. 中国循环杂志, 2016, 31(10):937-953.
	Joint Committee on the Revision of Guidelines for the Prevention and Treatment of Dyslipidemia in Adults in China. Guidelines for prevention and treatment of dyslipidemia in adults in China(2016 revised edition)[J]. Chin Circ J, 2016, 31(10):937-953.
[18]	Yang XL, Li JX, Hu DS, et al. Predicting the 10-year risks of atherosclerotic cardiovascular disease in Chinese population:the China-PAR project(prediction for ASCVD risk in China)[J]. Circulation, 2016, 134(19):1430-1440. DOI URL
[19]	Guo ZT, Tang JY, Han HY, et al. Cardiovascular disease risk prediction models in the Chinese population-a systematic review and meta-analysis[J]. BMC Public Health, 2022, 22(1):1608. DOI URL
[20]	国家卫生健康委员会. 癌症疼痛诊疗规范(2018年版)[J]. 临床肿瘤学杂志, 2018, 23(10):937-944.
	National Health Commission of the People’s Republic of China. Standard diagnosis and treatment of cancer pain(version 2018)[J]. Chin Clin Oncol, 2018, 23(10):937-944.
[21]	郭云飞, 张春慧, 张振香, 等. 农村缺血性脑卒中患者脑卒中复发风险自我感知与客观复发风险的一致性及对策分析[J]. 中国全科医学, 2021, 24(21):2707-2716. DOI
	Guo YF, Zhang CH, Zhang ZX, et al. Self-perceived and objective recurrence risk of stroke in rural patients with ischemic stroke:consistency analysis and countermeasures[J]. Chin Gen Pract, 2021, 24(21):2707-2716.
[22]	中华医学会心血管病学分会, 中国康复医学会心脏预防与康复专业委员会, 中国老年学和老年医学会心脏专业委员会, 等. 中国心血管病一级预防指南[J]. 中华心血管病杂志, 2020, 48(12):1000-1038.
	Chinese Society of Cardiology,Cardiac Prevention and Rehabilitation Committee, Chinese Medical Association for Rehabilitation, Chinese Gerontology and Geriatric Society Cardiac Committee, et al. Primary prevention guidelines for cardiovascular diseases in China[J]. Chin J Cardiol, 2020, 48(12):1000-1038.
[23]	Thakkar J, Heeley EL, Chalmers J, et al. Inaccurate risk perceptions contribute to treatment gaps in secondary prevention of cardiovascular disease[J]. Intern Med J, 2016, 46(3):339-346. DOI PMID
[24]	Weinstein ND. Unrealistic optimism about susceptibility to health problems[J]. J Behav Med, 1982, 5(4):441-460. DOI PMID
[25]	杨艳艳, 康腾腾, 朱康宁, 等. 心血管疾病患者风险感知的研究进展[J]. 护士进修杂志, 2021, 36(7):591-595.
	Yang YY, Kang TT, Zhu KN, et al. Research progress on risk perception of patients with cardiovascular diseases[J]. J Nurses Train, 2021, 36(7):591-595.
[26]	Mentrup S, Harris E, Gomersall T, et al. Patients’ experiences of cardiovascular health education and risk communication:a qualitative synthesis[J]. Qual Health Res, 2020, 30(1):88-104. DOI URL
[27]	Seesawang J, Bowers B, Sansiriphun N. Developing personal sense of risk:a grounded theory in men with hypertension[J]. Int Nurs Rev, 2019, 66(2):290-298. DOI PMID
[28]	Schapira MM, Fletcher KE, Gilligan MA, et al. A framework for health numeracy:how patients use quantitative skills in health care[J]. J Health Commun, 2008, 13(5):501-517. DOI PMID
[29]	Plana N, Ibarretxe D, Cabré A, et al. Prevalence of atherogenic dyslipidemia in primary care patients at moderate-very high risk of cardiovascular disease. Cardiovascular risk perception[J]. Clin Investig Arterioscler, 2014, 26(6):274-284. DOI PMID
[30]	Desgraz B, Collet TH, Rodondi N, et al. Comparison of self-perceived cardiovascular disease risk among smokers with Framingham and PROCAM scores:a cross-sectional analysis of baseline data from a randomised controlled trial[J]. BMJ Open, 2017, 7(1):e012063. DOI URL
[31]	刘晓聪, 冯颖青, 陈纪言. 心血管疾病风险评估模型研究进展[J]. 中国实用内科杂志, 2021, 41(5):428-433.
	Liu XC, Feng YQ, Chen JY. Research progress of cardiovascular disease risk assessment models[J]. Chin J Pract Intern Med, 2021, 41(5):428-433.
[32]	雷吉娜·E·朗格林, 安德莉亚·H·麦克马金. 风险沟通:环境、安全和健康风险沟通指南[M]. 黄河,蒲信竹,刘琳琳,译. 北京: 中国传媒大学出版社, 2016.
	Regina Lundgren, Andrea Mc Makin. Risk communication:a handbook of communicating environment,safety,and health risks[M]. Huang H,Pu XZ,Liu LL,translator. Beijing: Commu-nication University of China Press,2016.
[33]	孙丽, 吴瑛. 解读《欧洲心血管病预防指南》中护士的重要作用[J]. 中华护理杂志, 2014, 49(2):253-256.
	Sun L, Wu Y. Update for the strategic roles of nurses in cardiovascular disease prevention by application of European guidelines on cardiovascular disease prevention in clinical practice[J]. Chin J Nurs, 2014, 49(2):253-256.
[34]	任慧, 张振香, 林蓓蕾, 等. 护士主导的心血管疾病高危人群发病风险沟通策略研究进展[J]. 中华护理杂志, 2022, 57(4):431-436. DOI
	Ren H, Zhang ZX, Lin BL, et al. Research progress on nurse-led risk communication strategies for high-risk groups of cardiovascular diseases[J]. Chin J Nurs, 2022, 57(4):431-436. DOI