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Risk-taking attitudes and their association with process and outcomes of cardiac care: a cohort study.

King KM, Norris CM, Knudtson ML, Ghali WA - BMC Cardiovasc Disord (2009)

Bottom Line: Having risk-prone attitudes was associated with younger age (p < .001), male sex (p < .001), current smoking (p < .001) and higher household income (p < .001).Having risk-prone attitudes was associated with better survival in an unadjusted survival analysis (Hazard Ratio [HR] = 0.78 (95% CI 0.66-0.93), but not in a risk-adjusted analysis (HR = 0.92, 95% CI 0.77-1.10).An awareness of these associations could help healthcare providers as they counsel patients regarding cardiac care decisions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Health and Policy Studies, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. kingk@ucalgary.ca

ABSTRACT

Background: Prior research reveals that processes and outcomes of cardiac care differ across sociodemographic strata. One potential contributing factor to such differences is the personality traits of individuals within these strata. We examined the association between risk-taking attitudes and cardiac patients' clinical and demographic characteristics, the likelihood of undergoing invasive cardiac procedures and survival.

Methods: We studied a large inception cohort of patients who underwent cardiac catheterization between July 1998 and December 2001. Detailed clinical and demographic data were collected at time of cardiac catheterization and through a mailed survey one year post-catheterization. The survey included three general risk attitude items from the Jackson Personality Inventory. Patients' (n = 6294) attitudes toward risk were categorized as risk-prone versus non-risk-prone and were assessed for associations with baseline clinical and demographic characteristics, treatment received (i.e., medical therapy, coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI)), and survival (to December 2005).

Results: 2827 patients (45%) were categorized as risk-prone. Having risk-prone attitudes was associated with younger age (p < .001), male sex (p < .001), current smoking (p < .001) and higher household income (p < .001). Risk-prone patients were more likely to have CABG surgery in unadjusted (Odds Ratio [OR] = 1.21; 95% CI 1.08-1.36) and adjusted (OR = 1.18; 95% CI 1.02-1.36) models, but were no more likely to have PCI or any revascularization. Having risk-prone attitudes was associated with better survival in an unadjusted survival analysis (Hazard Ratio [HR] = 0.78 (95% CI 0.66-0.93), but not in a risk-adjusted analysis (HR = 0.92, 95% CI 0.77-1.10).

Conclusion: These exploratory findings suggest that patient attitudes toward risk taking may contribute to some of the documented differences in use of invasive cardiac procedures. An awareness of these associations could help healthcare providers as they counsel patients regarding cardiac care decisions.

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Kaplan-Meier Plot for Survival Based on Risk Attitudes (risk-prone versus non-risk-prone).
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Figure 3: Kaplan-Meier Plot for Survival Based on Risk Attitudes (risk-prone versus non-risk-prone).

Mentions: Figure 3 presents a Kaplan-Meier plot of survival in risk-prone versus non-risk-prone patients. Using the date of cardiac catheterization as time zero in the survival analysis, we found that having risk-prone attitudes was associated with better survival over the follow up period, which for some patients was as long as 7.5 years (estimated survival at 7.5 years: 89% for the risk-prone group versus 85% for the non-risk-prone group; log rank test 8.02, p = 0.005). We also used Cox proportional hazards regression models to examine the unadjusted and adjusted relative risk of death in patients who had risk-prone versus non-risk-prone attitudes. The unadjusted models revealed the hazard ratio for death in patients with risk-prone attitudes was 0.78 (95% CI 0.66–0.93). When we adjusted for all the characteristics shown in Table 1, the corresponding hazard ratio was 0.92 (95% CI 0.77–1.09). When we further adjusted this model for all characteristics shown in Table 1and treatment received, the hazard ratio for death in patients with risk-prone attitudes was similar at 0.93 (95% CI 0.79–1.11). The apparent protective association of risk-prone attitude with survival thus became statistically insignificant after controlling for the clinical and demographic variables. However, the effect was not changed when controlling also for treatment received. Thus clinical and demographic variables, and not treatment choice, influence the association between having risk-prone attitudes and survival.


Risk-taking attitudes and their association with process and outcomes of cardiac care: a cohort study.

King KM, Norris CM, Knudtson ML, Ghali WA - BMC Cardiovasc Disord (2009)

Kaplan-Meier Plot for Survival Based on Risk Attitudes (risk-prone versus non-risk-prone).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2734744&req=5

Figure 3: Kaplan-Meier Plot for Survival Based on Risk Attitudes (risk-prone versus non-risk-prone).
Mentions: Figure 3 presents a Kaplan-Meier plot of survival in risk-prone versus non-risk-prone patients. Using the date of cardiac catheterization as time zero in the survival analysis, we found that having risk-prone attitudes was associated with better survival over the follow up period, which for some patients was as long as 7.5 years (estimated survival at 7.5 years: 89% for the risk-prone group versus 85% for the non-risk-prone group; log rank test 8.02, p = 0.005). We also used Cox proportional hazards regression models to examine the unadjusted and adjusted relative risk of death in patients who had risk-prone versus non-risk-prone attitudes. The unadjusted models revealed the hazard ratio for death in patients with risk-prone attitudes was 0.78 (95% CI 0.66–0.93). When we adjusted for all the characteristics shown in Table 1, the corresponding hazard ratio was 0.92 (95% CI 0.77–1.09). When we further adjusted this model for all characteristics shown in Table 1and treatment received, the hazard ratio for death in patients with risk-prone attitudes was similar at 0.93 (95% CI 0.79–1.11). The apparent protective association of risk-prone attitude with survival thus became statistically insignificant after controlling for the clinical and demographic variables. However, the effect was not changed when controlling also for treatment received. Thus clinical and demographic variables, and not treatment choice, influence the association between having risk-prone attitudes and survival.

Bottom Line: Having risk-prone attitudes was associated with younger age (p < .001), male sex (p < .001), current smoking (p < .001) and higher household income (p < .001).Having risk-prone attitudes was associated with better survival in an unadjusted survival analysis (Hazard Ratio [HR] = 0.78 (95% CI 0.66-0.93), but not in a risk-adjusted analysis (HR = 0.92, 95% CI 0.77-1.10).An awareness of these associations could help healthcare providers as they counsel patients regarding cardiac care decisions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Health and Policy Studies, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. kingk@ucalgary.ca

ABSTRACT

Background: Prior research reveals that processes and outcomes of cardiac care differ across sociodemographic strata. One potential contributing factor to such differences is the personality traits of individuals within these strata. We examined the association between risk-taking attitudes and cardiac patients' clinical and demographic characteristics, the likelihood of undergoing invasive cardiac procedures and survival.

Methods: We studied a large inception cohort of patients who underwent cardiac catheterization between July 1998 and December 2001. Detailed clinical and demographic data were collected at time of cardiac catheterization and through a mailed survey one year post-catheterization. The survey included three general risk attitude items from the Jackson Personality Inventory. Patients' (n = 6294) attitudes toward risk were categorized as risk-prone versus non-risk-prone and were assessed for associations with baseline clinical and demographic characteristics, treatment received (i.e., medical therapy, coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI)), and survival (to December 2005).

Results: 2827 patients (45%) were categorized as risk-prone. Having risk-prone attitudes was associated with younger age (p < .001), male sex (p < .001), current smoking (p < .001) and higher household income (p < .001). Risk-prone patients were more likely to have CABG surgery in unadjusted (Odds Ratio [OR] = 1.21; 95% CI 1.08-1.36) and adjusted (OR = 1.18; 95% CI 1.02-1.36) models, but were no more likely to have PCI or any revascularization. Having risk-prone attitudes was associated with better survival in an unadjusted survival analysis (Hazard Ratio [HR] = 0.78 (95% CI 0.66-0.93), but not in a risk-adjusted analysis (HR = 0.92, 95% CI 0.77-1.10).

Conclusion: These exploratory findings suggest that patient attitudes toward risk taking may contribute to some of the documented differences in use of invasive cardiac procedures. An awareness of these associations could help healthcare providers as they counsel patients regarding cardiac care decisions.

Show MeSH