The Impact of Partner Bereavement on Quality of Cardiovascular Disease Management
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 pre-existing cardiovascular disease (CHD, Hypertension, Diabetes, 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 in comparison to 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, while in the controls uptake was relatively stable. The odds ratio for change was 1.30 (95% CI 1.15-1.46) for cholesterol measurement and 1.40 (1.22-1.61) for blood pressure measurement. For all medication, there was a transient fall in prescribing in the peri-bereavement period lasting approximately until three months after bereavement. The odds ratio for at least 80% prescription coverage in the 30 days after bereavement was 0.80 (0.73-0.88) for lipid lowering medication and 0.82 (0.74-0.91) for antiplatelet medication compared to 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 period.
- Received May 30, 2013.
- Revision received August 16, 2013.
- Accepted September 13, 2013.