Association Between Primary Care Practitioner Empathy and Risk of Cardiovascular Events and All-Cause Mortality Among Patients With Type 2 Diabetes: A Population-Based Prospective Cohort Study

Abstract

Objective: To examine the association between primary care practitioner empathy and incidence of cardiovascular disease (CVD) events and all-cause mortality among patients with type 2 diabetes Design: Population-based cohort study Setting: 49 general practices in the UK Population: 867 individuals with screen-detected type 2 diabetes who were followed up for an average of ten years until 31st December 2014 in the ADDITION-Cambridge trial Exposure: Twelve months after diagnosis, patients assessed practitioner empathy, and their experiences of diabetes care over the preceding year using the consultation and relational empathy (CARE) questionnaire. CARE scores were grouped into tertiles. Main outcome measures: First recorded CVD-event (composite of myocardial infarction, revascularization, non-traumatic amputation, stroke or fatal event) and all-cause mortality was obtained from electronic searches of the GP record, national registers and hospital records. Hazard ratios (HR) were estimated using Cox models adjusted for confounders Results: Of the 628 participants who completed the CARE score, 120 (19%) experienced a CVD event and 132 participants (21%) died during follow up. In multivariable models, compared to the lowest tertile higher empathy scores were associated with lower risk of CVD events (although this did not achieve statistical significance) and lower risk of all-cause mortality (HR for the middle and highest tertiles respectively: 0.49, 95% CI 0.27 to 0.88, p=0.01 and 0.60, 95% 0.35 to 1.04, p=0.05). Conclusion: Positive patient experiences of practitioner empathy in the year following diagnosis of type 2 diabetes may be associated with beneficial long-term clinical outcomes. Further work is needed to understand how and which aspects of patient perceptions of empathy might influence outcomes and to incorporate this understanding into education and training of practitioners

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ORCID for Hajira Dambha-Miller: orcid.org/0000-0003-0175-443X

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