Patient-clinician communication and cardiovascular outcomes: An analysis of the hispanic community health study/study of latinos (HCHS/SOL), 2008-2019

Abstract

Background

Strong patient-clinician communication may improve health outcomes for Hispanic/Latino individuals.

Objective

We assessed the association between patient-clinician communication and cardiovascular (CV) events or death in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Methods

HCHS/SOL is a longitudinal cohort study of individuals aged 18–74 who identified as Hispanic/Latino at 4 U.S. metropolitan areas. Participants' ratings of communication with clinicians during the year before enrollment were used to generate a 3-level communication score. The primary outcome was the composite of myocardial infarction (MI), heart failure events (HF), stroke, and all-cause mortality. The secondary outcomes included the components of the primary outcome. The association between the baseline communication score and outcomes of interest was assessed with Cox proportional hazards models adjusting for possible confounders. We also used multivariable linear regression to assess the cross-sectional association between communication and AHA Life’s Essential 8 (LE8), a measure of CV risk factors. All analyses accounted for the complex survey design.

Results

Our sample included 10,527 individuals without prior CV events and at least one medical encounter in the year before enrollment. The median age at enrollment was 41 years (IQR 29, 53), 59% were female, and 71% perceived high-quality communication with clinicians. The mean follow-up time was 9.4 years. High-quality communication was associated with the following results in our fully adjusted analyses: composite outcome (aHR 0.73; 95% CI 0.51, 1.03; p = 0.073), CV events (aHR 0.82, 95% CI 0.44, 1.51, p = 0.520), all-cause mortality (aHR 0.54; 95% CI 0.37, 0.80; p = 0.002).

Conclusions

High-quality patient-clinician communication was associated with a non-significant trend toward a lower rate of CV events and death, driven by a significant association with lower all-cause mortality.