Hypertensive disorders of pregnancy among women with cardiovascular disease in Norway: A historical cohort study.

INTRODUCTION: Women with cardiovascular disease may be at increased risk of hypertensive disorders of pregnancy (HDP). We aimed to: (1) Investigate the occurrence of HDP in a cohort of pregnant women with cardiovascular disease and compare it with the occurrence in the general population. (2) Assess the association between maternal cardiovascular risk and risk of HDP. MATERIAL AND METHODS: We reviewed clinical data on a cohort of 901 pregnancies among 708 women with cardiovascular disease who were followed at the National Unit for Pregnancy and Heart Disease and gave birth at Oslo University Hospital between 2003 and 2018. The exposure under study was maternal cardiovascular risk, classified as low, moderate, or high based on a modified classification by the World Health Organization. The main outcome of interest was HDP, which included pre-eclampsia and gestational hypertension. The proportion of HDP cases in the general population in the same period was extracted from the Medical Birth Registry of Norway. We used logistic regression to estimate crude and adjusted odds ratios (OR) of HDP, with associated 95% confidence intervals (CIs), for women with moderate- and high cardiovascular risk compared to women with low risk. RESULTS: The occurrence of HDP in the study cohort was 12.1% (95% CI: 10.0%-14.4%) and varied between 8.7% (95% CI: 6.5%-11.3%) in the low-risk group, 15.7% (95% CI: 11.1%-21.4%) in the moderate-risk group, and 22.2% (95% CI: 15.1%-30.8%) in the high-risk group. By contrast, the nationwide occurrence of HDP was 5.1% (95% CI: 5.1%-5.2%). In the study cohort, the proportions of pregnancies with gestational hypertension and pre-eclampsia were similar (6.3% and 5.8%, respectively). Compared to pregnancies with low cardiovascular risk, the adjusted OR of HDP was 2.04 (95% CI: 1.21-3.44) in the moderate-risk group and 2.99 (95% CI: 1.73-5.18) in the high-risk group. CONCLUSIONS: The occurrence of hypertensive disease of pregnancy in the study cohort was more than doubled compared to the general population in Norway. The risk of HDP increased with maternal cardiovascular risk group. We recommend taking into account maternal cardiovascular risk group when assessing risk and prophylaxis of HDP.

Patient's satisfaction and distress compared with expectations of the medical staff.

OBJECTIVE: Patient satisfaction is increasingly used to measure and evaluate patient treatment in hospital. The aim of this study is to assess satisfaction regarding communication, support and the degree of anxiety and depression among the patients, and to compare reports from the patients with the expectations of the staff. METHODS: In a prospective study, 176 (93%) of the patients and 52 (80%) of the nurses completed a similar questionnaire. Degree of satisfaction was measured on a five-point scale (0-4), and degree of anxiety and depression was measured with the hospital anxiety and depression scale (HAD). RESULTS: Satisfaction regarding communication with nurses (3.4+/-0.07) and physicians (3.0+/-0.08) was higher than expected by the staff (2.9+/-0.09 and 2.4+/-0.09, respectively) (p<0.01). The staff expected a higher degree of anxiety (2.3+/-0.10 versus 1.5+/-0.12) (p<0.01). The patients scored significantly higher on HAD anxiety compared with the population in general. The HAD score correlated negatively with the level of satisfaction. CONCLUSION: The patients generally showed a high degree of satisfaction with communication and support. The staff underestimated the patients' degree of satisfaction and overestimated their degree of anxiety. PRACTICE IMPLICATIONS: Knowledge of patients' degree of satisfaction is important for satisfactory communication with the staff, compliance with treatment and in order to reduce staff's concern for their care.

Emotional strain, communication, and satisfaction of family members in the intensive care unit compared with expectations of the medical staff: experiences from a Norwegian University Hospital.

OBJECTIVES: To determine satisfaction in regard to information concerning, and support and facilities for relatives in the intensive care unit (ICU), and to compare this with the staff's expectations on these issues; to determine relatives' degree of psychological distress and use of hypnotics, anxiolytics, and antidepressants; finally, to compare the distress of relatives of survivors and relatives of non-survivors. DESIGN: Prospective study. SETTING: University-affiliated ICU. METHODS: Relatives of 50 patients who survived at least 6 days in the ICU and relatives of 18 non-survivors who stayed for at least 24 h anonymously completed a mailed questionnaire at home 4 weeks after treatment in the ICU. Forty-three staff members (69%) answered the questionnaire. The degree of satisfaction was measured on a five-point scale (0-4). MAIN RESULTS: The average satisfaction scores were 3.4+/-0.6 SD for relatives of survivors and 3.4+/-0.5 for relatives of non-survivors. Staff expected a significantly lower degree of satisfaction, with a score of 2.9+/-0.5 (P<0.001). The distress scores of relatives of survivors (2.7+/-1.0) were no higher than the ones of relatives of non-survivors (2.4+/-0.6) during the ICU stay, but significantly lower than staff expectations (3.2+/-0.5) (P<0.01). The use of medication was moderate. CONCLUSIONS: The relatives' satisfaction was greater than anticipated by the staff. Staff generally expected a higher degree of distress among relatives than was actually the case. Relatives were very satisfied with the support and communication in the ICU despite substantial distress. Relatives of survivors and non-survivors were equally satisfied.