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Padda I, Fabian D, Farid M, Mahtani A, Sethi Y, Ralhan T, Das M, Chandi S, Johal G. Social determinants of health and its impact on cardiovascular disease in underserved populations: A critical review. Curr Probl Cardiol 2024; 49:102373. [PMID: 38185436 DOI: 10.1016/j.cpcardiol.2024.102373] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024]
Abstract
In the United States, a patient succumbs to cardiovascular disease (CVD) every 33 seconds and costs the healthcare system close to $240 billion dollars annually. Social determinants of health (SDOH) are key factors responsible in structuring the well-being of individuals and communities. It significantly influences health outcomes and is reliant on several factors such as economic stability, education, healthcare access, community composition, and governmental policies. This review explores the impact of SDOH on the escalating global burden of CVD and identifies potential modifiable risk factors that contribute to acute coronary syndrome (ACS) among underserved communities. In addition, it also addresses the necessity for interventions to narrow healthcare related disparities ensuring improvement in CVD outcomes in this subgroup of population.
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Affiliation(s)
- Inderbir Padda
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA; PearResearch, Dehradun, India.
| | - Daniel Fabian
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA
| | - Meena Farid
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA
| | - Arun Mahtani
- Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA
| | - Yashendra Sethi
- PearResearch, Dehradun, India; Department of Medicine, Government Doon Medical College, Dehradun
| | - Tushar Ralhan
- School of Medicine, St. George's University, True Blue, Grenada
| | - Maumita Das
- School of Medicine, St. George's University, True Blue, Grenada
| | - Sonam Chandi
- Department of Quality and Patient Safety, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA
| | - Gurpreet Johal
- Valley Medical Centre, University of Washington, Seattle, US
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Chahraoui K, Laurent A, Bioy A, Quenot JP. Psychological experience of patients 3 months after a stay in the intensive care unit: A descriptive and qualitative study. J Crit Care 2015; 30:599-605. [DOI: 10.1016/j.jcrc.2015.02.016] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 02/24/2015] [Accepted: 02/26/2015] [Indexed: 11/25/2022]
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Parry M, Watt-Watson J. Peer Support Intervention Trials for Individuals with Heart Disease: A Systematic Review. Eur J Cardiovasc Nurs 2010; 9:57-67. [PMID: 19926339 DOI: 10.1016/j.ejcnurse.2009.10.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Revised: 10/16/2009] [Accepted: 10/24/2009] [Indexed: 11/16/2022]
Affiliation(s)
- Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada
| | - Judy Watt-Watson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada
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Chahraoui K, Reynaud M, Pinoit JM, Bénony H, Bonin B, Gisselmann A. [Styles of attachment and social support perceived in depressed women]. Encephale 2007; 32:944-52. [PMID: 17372537 DOI: 10.1016/s0013-7006(06)76271-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
RESULTS This study, inspired by the attachment model and research in the field of social support, attempts to reveal the link between styles of attachment, social support and depressive vulnerability. AIM OF THE STUDY It investigates current styles of attach-ment and the quality of social support perceived by 35 hospitalized, depressed subjects compared to 35 control subjects who exhibited no pathology. After giving their consent, each subject took part in an in-depth psychological investigation consisting of a recorded clinical interview and various clinical scales. METHOD The study presents only the responses to the Perception of Relations questionnaire which distinguishes between four styles of attachment (secure, detached, preoccupied and disorganized) and the Social Support Questionnaire (SSQ6) which contains two dimensions: social availability and social satisfaction. The results were subjected to statistical analyses: a comparative analysis between the two groups and a correlational analysis between the dimensions of social support and the dimensions of style of attachment. On the one hand, the study reveals that the social network is perceived to be less available by depressed subjects, together with the absence of a current intimate relationship with other people, the absence of people to confide in, and a relationship between this absence and the large number of losses experienced by depressed subjects, in particular the loss of figures of attachment (father and mother). On the other hand, depressed subjects tend to exhibit a preoccupied, disorganized style of attachment which is characterized by negative models of the self. DISCUSSION The discussion addresses the way these styles of attachment should be understood: do they represent the consequence of the depressive pathology or an older relational style?
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Affiliation(s)
- K Chahraoui
- Université de Bourgogne, Laboratoire de Psychologie Clinique et Sociale, Pôle AAFE, Esplanade Erasme, BP 26513, 21065 Dijon cedex
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Badoux-Levy A, Robin M, Lavarde AM, Grygielski V. [Psychological and social factors predictive of loneliness: a cognitive and behavioral approach]. Encephale 2004; 30:16-23. [PMID: 15029072 DOI: 10.1016/s0013-7006(04)95411-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objective of the present study was to explore the psychological and social mechanisms leading to loneliness. Based on cognitive and behavioral approaches developed in health psychology, we tested several models that might allow one to predict certain determinants of the feeling of loneliness. Included in the study were 45 individuals suffering from loneliness who had come to one of several Centres Thérapeutiques de Lutte contre l'Isolement "Recherche et Rencontres". The subjects were asked to respond to four scales: the UCLA loneliness scale, Cattell's 16 PF 5 personality scale, Sherbourne and Stewart's social support scale, and Lazarus and Folkman's Ways of Coping Checklist. The present results confirm the previously reported deficit of social support perceived by subjects in this population. Concerning their personality, this population sample falls outside national norms in 7 dimensions: compared to the general population, the socially isolated individual appears essentially to be introverted and anxious, emotionally unstable, avoiding conflicts, timid and ill at ease in the company of -others, imaginative and distracted. To face up to their feeling of loneliness, they have a tendency to use coping styles such as "keep it to yourself" and "wishful thinking". On the other hand, they resort very little to social support. Among the pertinent variables, 5 predictive factors were recognized, and they could explain 51% of the variance in the feeling of loneliness: they include the global score of perceived social support, coping strategies focussed around wishful thinking, coping strategies that avoid resort to social support, personality traits of imaginativeness and absent-mindedness, and an introverted personality. Three predictors contributed independently to the model: absence of resort to social support, the use of wishful thinking, and the imaginative-distracted personality trait. We likewise found evidence for a mediator role of the absence of resort to social support in the relation between the levels of perceived social support and the feeling of loneliness. Thus it is not so much the deficit in the subject's social relations that determines his feeling of loneliness as it is his difficulty of appealing to others when in distress. These results suggest that it would be judicious to develop specific therapeutic interventions for this type of person that would permit them to adjust more actively and to behave more realistically.
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Affiliation(s)
- A Badoux-Levy
- Laboratoire de Psychologie Environnementale, Université Paris V, 71, avenue Edouard-Vaillant, 92100 Boulogne
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Promotion of emotional disclosure following illness and injury: A brief intervention for medical patients and their families. COGNITIVE AND BEHAVIORAL PRACTICE 2003. [DOI: 10.1016/s1077-7229(03)80053-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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O'Shea JC, Wilcox RG, Skene AM, Stebbins AL, Granger CB, Armstrong PW, Bode C, Ardissino D, Emanuelsson H, Aylward PE, White HD, Sadowski Z, Topol EJ, Califf RM, Ohman EM. Comparison of outcomes of patients with myocardial infarction when living alone versus those not living alone. Am J Cardiol 2002; 90:1374-7. [PMID: 12480048 DOI: 10.1016/s0002-9149(02)02876-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J Conor O'Shea
- Duke Clinical Research Institute, Durham, North Carolina, USA.
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Knox SS. Psychosocial factors in cardiovascular disease: implications for therapeutic outcomes. Expert Rev Pharmacoecon Outcomes Res 2002; 2:147-59. [DOI: 10.1586/14737167.2.2.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
OBJECTIVES The objectives of the study were to identify the characteristics of a problematic doctor-patient relationship from the perspective of primary care patients who are cared for by medical residents and to determine whether patients' perception of the relationship is a function of their demographic, clinical, or social attributes. DESIGN Cross-sectional survey. SETTING An adult primary care practice in an academic medical center. PATIENTS One hundred fifty-one patients whose primary care physicians were senior internal medicine residents. MEASUREMENTS AND MAIN RESULTS Patients completed a questionnaire addressing several aspects of their doctor-patient relationship, the general health perception item on the SF-12, and items on social support from the Duke Social Support and Stress Scale. By design of the study, approximately half of the patients had been identified by their physicians as being in problematic relationships (n = 74) and half as being in satisfying relationships (n = 77). Among patients in relationships described as satisfying by their resident, 10% viewed the relationship as problematic. Of the patients involved in relationships described as problematic by the resident, 23% viewed their relationship as problematic (P = .03). Patients who rated the relationship as problematic were much more likely to also report low social support compared to patients involved in relationships described as satisfying (76% vs 16%; P < .001). Compared to residents involved in relationships described as satisfying by their patients, residents in problematic relationships were more likely to be described as being less accessible and less capable of handling medical complaints (P < . 001). CONCLUSIONS Patients were more likely to describe the doctor-patient relationship as problematic if they felt that the resident was less accessible or less capable of handling medical complaints, or if they had low self-perceived social support.
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Affiliation(s)
- C Boutin-Foster
- Department of Medicine, Weill Medical College of Cornell University, New York, NY 10021, USA.
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Tsuchihashi M, Tsutsui H, Kodama K, Kasagi F, Setoguchi S, Mohr M, Kubota T, Takeshita A. Medical and socioenvironmental predictors of hospital readmission in patients with congestive heart failure. Am Heart J 2001; 142:E7. [PMID: 11579371 DOI: 10.1067/mhj.2001.117964] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with chronic congestive heart failure (CHF) require frequent rehospitalization because of the exacerbation of CHF. It is of clinical importance to determine predicting factors for readmission to reduce this likelihood. Previous studies have focused primarily on the demographic and medical characteristics in selected subsets of patients. Therefore, within a broad cohort of consecutively hospitalized patients, we sought to identify not only demographic and medical predictors but also socioenvironmental factors associated with readmission. METHODS We assessed demographic (age, sex), medical (etiology of CHF, New York Heart Association functional class, left ventricular ejection fraction, previous admission for CHF, length of hospital stay, comorbidity, and medications), and socioenvironmental variables (occupation, financial resources, living alone, and follow-up visits) in 230 patients discharged with a diagnosis of CHF and recorded hospital readmission. RESULTS Within 1 year after discharge, 81 patients (35%) were readmitted. Five variables, including poor follow-up visits (odds ratio [OR] 4.9, 95% CI 2.0-11.8), previous admission for CHF (OR 3.3, 95% CI 1.8-6.1), no occupation (OR 2.6, 95% CI 1.2-5.5), longer hospital stay (OR 3.2, 95% CI 1.2-8.5), and hypertension (OR 2.0, 95% CI 1.1-3.7), were identified as significant independent predictors for readmission by multivariate logistic regression analysis. CONCLUSIONS Our independent predictors of readmission support the importance of medical and socioenvironmental factors in the deterioration of CHF. Therefore interventions to decrease readmission should also target social management in all hospitalized patients.
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Affiliation(s)
- M Tsuchihashi
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2001:CD001800. [PMID: 11279730 DOI: 10.1002/14651858.cd001800] [Citation(s) in RCA: 379] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The burden of cardiovascular disease world-wide is one of great concern to patients and health care agencies alike. Cardiac rehabilitation aims to restore patients with heart disease to health through exercise only based rehabilitation or comprehensive cardiac rehabilitation. OBJECTIVES To determine the effectiveness of exercise only or exercise as part of a comprehensive cardiac rehabilitation programme on the mortality, morbidity, health-related quality of life (HRQoL) and modifiable cardiac risk factors of patients with coronary heart disease. SEARCH STRATEGY Electronic databases were searched for randomised controlled trials, using standardised trial filters, from the earliest date available to December 31st 1998. SELECTION CRITERIA Men and women of all ages, in hospital or community settings, who have had myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty, or who have angina pectoris or coronary artery disease defined by angiography. DATA COLLECTION AND ANALYSIS Studies were selected independently by two reviewers, and data extracted independently. Authors were contacted where possible to obtain missing information. MAIN RESULTS This systematic review has allowed analysis of an increased number of patients from approximately 4500 in earlier meta-analyses to 8440 (7683 contributing to the total mortality outcome). The pooled effect estimate for total mortality for the exercise only intervention shows a 27% reduction in all cause mortality (random effects model OR 0.73 (0.54, 0.98)). Comprehensive cardiac rehabilitation reduced all cause mortality, but to a lesser degree (OR 0.87 (0.71, 1.05)). Total cardiac mortality was reduced by 31% (random effects model OR 0.69 (0.51, 0.94)) and 26% (random effects model OR 0.74 (0.57, 0.96)) in the exercise only and comprehensive cardiac rehabilitation groups respectively. Neither intervention had any effect on the occurrence of non-fatal myocardial infarction. There was a significant net reduction in total cholesterol (pooled WMD random effects model -0.57 mmol/l (-0.83, -0.31)) and LDL (pooled WMD random effects model -0.51 mmol/l (-0.82, -0.19) in the comprehensive cardiac rehabilitation group. REVIEWER'S CONCLUSIONS Exercise-based cardiac rehabilitation is effective in reducing cardiac deaths. It is not clear from this review whether exercise only or a comprehensive cardiac rehabilitation intervention is more beneficial. The population studied in this review is still predominantly male, middle aged and low risk. Identification of the ethnic origin of the participants was seldom reported. It is possible that patients who would have benefited most from the intervention were excluded from the trials on the grounds of age, sex or co-morbidity.
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Affiliation(s)
- J A Jolliffe
- Research and Development Support Unit, Noy Scott House, Haldon View terrace, Exeter, Devon, UK, EX2 5EQ.
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Lindsay GM, Smith LN, Hanlon P, Wheatley DJ. The influence of general health status and social support on symptomatic outcome following coronary artery bypass grafting. Heart 2001; 85:80-6. [PMID: 11119470 PMCID: PMC1729595 DOI: 10.1136/heart.85.1.80] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To assess health status, level of social support, and presence of coronary artery disease risk factors before and after coronary artery bypass grafting (CABG); to assess symptomatic relief approximately 12 months postoperatively; and to examine the association between preoperative health status and recurrence of symptoms. DESIGN Observational study. SETTING Preoperatively, in hospital outpatient department (1995-1996); postoperatively, at home (1996-97). SUBJECTS AND METHODS Patients awaiting elective CABG were recruited one month before the expected date of operation. Preoperative assessment included severity of symptoms, coronary artery disease risk factors, short form 36 (SF-36) questionnaire, and social activities questionnaire. The presence and severity of angina and breathlessness were reported postoperatively (mean 16.4 months). Multiple regression analysis was used to identify factors associated with improved outcome following CABG. MAIN OUTCOME MEASURE Patient reported presence and severity of angina and breathlessness. RESULTS 183 patients were followed for a mean of 16. 4 months after CABG. Angina and breathlessness were completely relieved in 55% and 36% of patients, respectively. In patients with residual symptoms, the severity was significantly reduced (angina p < 0.001; breathlessness, p = 0.02). Patients with low SF-36 scores and low social network scores preoperatively were less likely to be relieved of symptoms (p < 0.001). Health status and social support levels preoperatively were lower than in other reported coronary artery disease patients groups. Preoperatively, coronary artery disease risk factors were higher than recommended in current guidelines: 67.4% had raised plasma cholesterol, 39.0% were hypertensive, 80% were moderately obese, and 22.9% were smokers. CONCLUSIONS Recurrence of symptoms exceeded other published studies. Patients' perception of general health, symptoms, and social support influences outcome.
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Affiliation(s)
- G M Lindsay
- Nursing and Midwifery School, University of Glasgow, 68 Oakfield Avenue, Glasgow G12 8LS, UK.
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Abstract
OBJECTIVE Acute and chronic psychological distress have been associated with coronary heart disease (CHD) but little is known about the determinants of distress as a coronary risk factor. Broad and stable personality traits may have much explanatory power; this article selectively focuses on negative affectivity (NA; tendency to experience negative emotions) and social inhibition (SI; tendency to inhibit self-expression in social interaction) in the context of CHD. METHODS The first part of this article reviews research on NA and SI in patients with CHD. The second part presents new findings on NA and SI in 734 patients with hypertension. RESULTS Accumulating evidence suggests that the combination of high NA and high SI designates a personality subtype ("distressed" type or type D) of coronary patients who are at risk for clustering of psychosocial risk factors and incidence of long-term cardiac events. Type D and its contributing low-order traits (dysphoria/tension and reticence/withdrawal) could also be reliably assessed in a community-based sample of patients with hypertension. This finding was replicated in men and women, and in Dutch- and French-speaking subjects. Type D hypertensives reported more depressive affect than their non type D counterparts. CONCLUSIONS There is an urgent need to adopt a personality approach in the identification of patients at risk for cardiac events. NA and SI are broad and stable personality traits that may be of special interest not only in CHD, but in other chronic medical conditions as well.
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Affiliation(s)
- J Denollet
- Department of Clinical Health Psychology, Tilburg University, Netherlands.
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Clarke SP, Frasure-Smith N, Lespérance F, Bourassa MG. Psychosocial factors as predictors of functional status at 1 year in patients with left ventricular dysfunction. Res Nurs Health 2000; 23:290-300. [PMID: 10940954 DOI: 10.1002/1098-240x(200008)23:4<290::aid-nur5>3.0.co;2-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Chronic heart failure patients often experience significant functional impairments. A better understanding of the biopsychosocial correlates of functional status may lead to interventions that improve quality of life in this population. Social isolation, mood disturbance, low socioeconomic status, and non-White ethnicity were evaluated as possible correlates of impaired functional status in 2,992 U.S. patients with left ventricular ejection fractions (LVEFs) </= 35%. Even after controlling for age and clinical characteristics, all of the psychosocial variables examined were significant predictors of risk for experiencing severe limitations in intermediate and social activities of daily living at 1 year, with adjusted odds ratios in the 1.5-2.0 range. The ability of psychosocial characteristics to predict future functional status was also independent of baseline functional status, comorbid medical conditions, and deterioration in heart failure signs and symptoms over the intervening year. These results suggest that psychosocial factors influence patient functional status even in the later phases of cardiac disease.
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Abstract
Social support is now recognized as a major determinant of physical and mental health. The purpose of the present study was to assess social support in two groups of French people, one consisting of apparently healthy adults recruited in the general population, the other of adults recruited in centres providing psychosocial therapy to people feeling lonely and isolated. Social support was measured using a French translation of the Sherbourne and Stewart social support scale. This scale measures the perceived availability of functional support in four dimensions (tangible, affectionate, emotional/informational and positive social interaction). The results indicate that the healthy adults have good social support, whereas those feeling lonely and isolated have poor social support. In addition, after six to 12 months of therapy, the centres' subjects showed significant improvement in their level of social support. These data could serve as references for studies on social support in different cultures.
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Hemingway H, Marmot M. Evidence based cardiology: psychosocial factors in the aetiology and prognosis of coronary heart disease. Systematic review of prospective cohort studies. BMJ (CLINICAL RESEARCH ED.) 1999; 318:1460-7. [PMID: 10346775 PMCID: PMC1115843 DOI: 10.1136/bmj.318.7196.1460] [Citation(s) in RCA: 770] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- H Hemingway
- International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, London WC1E 6BT.
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Affiliation(s)
- J Dinnes
- NHS Centre for Reviews and Dissemination, University of York, USA
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Griffith CH, Wilson JF, Rich EC. A randomized trial of providing house staff with patient social history information. Effect on patient outcomes. Eval Health Prof 1998; 21:362-76. [PMID: 10350956 DOI: 10.1177/016327879802100304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this project was to assess if providing physicians (house staff) with routine comprehensive social history information on their patients will improve patient outcomes. Comprehensive social history information was gathered over a 5-month period on 134 consecutive patients. Patients were randomized to have social history information provided or not provided to the resident physician caring for them. Outcomes of interest were: patient satisfaction, length of stay, and early unplanned readmission. Analysis was with analysis of covariance, controlling for patient severity of illness and amount of social history information documented by the house officer. Outcomes were the same for patients for whom house staff were provided social history information versus those for whom the information was not provided. The authors conclude that providing house staff with routine comprehensive social history information did not influence patient outcomes.
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Krumholz HM, Butler J, Miller J, Vaccarino V, Williams CS, Mendes de Leon CF, Seeman TE, Kasl SV, Berkman LF. Prognostic importance of emotional support for elderly patients hospitalized with heart failure. Circulation 1998; 97:958-64. [PMID: 9529263 DOI: 10.1161/01.cir.97.10.958] [Citation(s) in RCA: 237] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several studies have indicated that a variety of social relationships are important predictors of morbidity and mortality in patients with coronary artery disease, but little attention has been focused on the prognostic importance of these factors in the growing population of elderly patients with heart failure. To address this issue, we sought to determine whether emotional support is associated with fatal and nonfatal cardiovascular events in elderly patients hospitalized with heart failure. METHODS AND RESULTS We reviewed the medical records of 292 subjects aged > or =65 years who were hospitalized with clinical heart failure and were part of the New Haven, Conn, cohort of the Established Population for the Epidemiologic Study of the Elderly, a longitudinal, community-based study of aging that included a comprehensive assessment of psychosocial support. In the unadjusted analysis, lack of emotional support was significantly associated with the 1-year risk of fatal and nonfatal cardiovascular outcomes [odds ratio, 2.4; 95% confidence interval, 1.1 to 4.9]. After adjustment for demographic factors, clinical severity, comorbidity and functional status, social ties, and instrumental support, the absence of emotional support remained associated with a significantly higher risk (odds ratio, 3.2; 95% confidence interval, 1.4 to 7.8). The test for interaction between emotional support and sex was significant (P=.01). In the fully adjusted model, the odds ratio for women was 8.2 (95% confidence interval, 2.5 to 27.2) compared with 1.0 (95% confidence interval, 0.3 to 3.3) for men. CONCLUSIONS Among elderly patients hospitalized with clinical heart failure, the absence of emotional support, measured before admission, is a strong, independent predictor of the occurrence of fatal and nonfatal cardiovascular events in the year after admission. In this cohort, the association is restricted to women.
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Affiliation(s)
- H M Krumholz
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06520-8025, USA.
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Denollet J, Brutsaert DL. Personality, disease severity, and the risk of long-term cardiac events in patients with a decreased ejection fraction after myocardial infarction. Circulation 1998; 97:167-73. [PMID: 9445169 DOI: 10.1161/01.cir.97.2.167] [Citation(s) in RCA: 270] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with myocardial infarction (MI) with a decreased left ventricular ejection fraction (LVEF) have a poor prognosis, but the role of emotional stress in prognosis is not known. We hypothesized that emotional stress in these patients (1) is unrelated to the severity of cardiac disorder, (2) predicts cardiac events, and (3) is a function of basic personality traits. METHODS AND RESULTS Eighty-seven patients with MI (age, 41 to 69 years) with an LVEF of < or =50% underwent psychological assessment at baseline. Patients and their families were contacted after 6 to 10 years (mean, 7.9 years); cardiac events were defined as cardiac death or nonfatal MI. Emotional distress was unrelated to the severity of cardiac disorder. At follow-up, 21 patients had experienced a cardiac event (13 fatal events). These events were related to LVEF of < or =30%, poor exercise tolerance, previous MI, anxiety, anger, and depression (all P< or =.02). Patients with a distressed personality (type D; ie, the tendency to suppress negative emotions) were more likely to experience an event over time compared with non-type D patients (P=.00005). Cox proportional hazards analysis yielded LVEF of < or =30% (relative risk, 3.0; 95% confidence interval, 1.2 to 7.7; P=.02) and type D (relative risk, 4.7; 95% confidence interval, 1.9 to 11.8; P=.001) as independent predictors. Anxiety, anger, and depression did not add to the predictive power of type D; these negative emotions were highly correlated and reflected the personality domain of negative affectivity. CONCLUSIONS Personality influences the clinical course of patients with a decreased LVEF. Emotional distress in these patients is unrelated to disease severity but reflects individual differences in personality. Clinical trials should take a broad view of the target of intervention; assessment of LVEF and personality may identify patients at risk.
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Affiliation(s)
- J Denollet
- Department of Medicine, University of Antwerp, Belgium
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Woloshin S, Schwartz LM, Tosteson AN, Chang CH, Wright B, Plohman J, Fisher ES. Perceived adequacy of tangible social support and health outcomes in patients with coronary artery disease. J Gen Intern Med 1997; 12:613-8. [PMID: 9346457 PMCID: PMC1497172 DOI: 10.1046/j.1525-1497.1997.07121.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Health outcomes of patients with chronic disease might be influenced by assistance from others in performing daily activities. We examined whether perceived adequacy of such tangible support was associated with prognosis in a cohort of patients with coronary artery disease. DESIGN Longitudinal cohort study. SETTING/PARTICIPANTS In spring 1993, a cohort of 1,468 patients with chronic artery disease was identified using claims data. The cohort consisted of all surviving residents of Manitoba, Canada, who had been hospitalized for acute myocardial infarction from 1991 to 1992: 820 patients completed the initial survey, and 734 completed a follow-up survey approximately 1 year later. MEASUREMENTS AND MAIN RESULTS Adequacy of tangible support was assessed by asking if respondents needed help at home because of health problems, and whether these needs were met. We examined the association between perceived adequacy of tangible support and health outcomes at 1 year (mortality, physical function). Of 820 participants, 74% perceived no need for help, 13% had sufficient help, 9% needed more help, and 5% needed much more help; 31 patients died during follow-up. After adjustment for age and initial health status, odds ratios (95% confidence interval) for death were: sufficient help 1.8 (0.61, 5.8); need more help 3.2 (1.1, 9.4); and need much more help 6.5 (2.0, 21.6) compared with respondents with no perceived need. Decline in physical function was also linearly related to perceiving less-adequate tangible support. Sensitivity analyses indicated it is highly improbable that results were due to selection bias. CONCLUSIONS Perceived lack of needed assistance was related to mortality and to decline in physical functioning. Adequacy of tangible support was an important prognostic factor for these patients with coronary artery disease and may be a determinant of health outcomes.
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Affiliation(s)
- S Woloshin
- Department of Veterans Affairs Medical Center, White River Junction, Vt. 05009, USA
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Du W, Ash AS, Berlowitz DR, Schwartz JS, Moskowitz MA. Variations in the management of acute myocardial infarction. Importance of clinical measures of disease severity. J Gen Intern Med 1996; 11:334-41. [PMID: 8803739 DOI: 10.1007/bf02600043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the extent to which resource use for patients hospitalized with acute myocardial infarction varies with clinical status, and to see if an observed difference in resource use between two states can be explained by clinically detailed risk adjustment. DESIGN Retrospective review of the clinical characteristics and resource use of 342 patients hospitalised in two states with acute myocardial infarction. DATA SOURCES Merged data from three sources: a large, existing research database used in developing the Medicare Mortality Predictor Score, clinical data abstracted from medical charts specifically for this study, and Medicare Parts A and B claims records. PATIENTS A probability sample of Medicare patients hospitalized in 1986 with a diagnosis of acute myocardial infarction and residing in either Wisconsin or Washington state; patients dying within 30 days are oversampled. MEASUREMENTS AND MAIN RESULTS Although patients were clinically similar in the two states, there were systematic differences in resource use. Patients in Wisconsin spent more than one extra day in the intensive care unit (ICU) (2.8 vs 1.7) as well as more than one extra non-ICU day in the hospital (8.0 vs 6.5) than patients in Washington. Patients in Wisconsin were also more likely to receive an echocardiogram (35.6% vs 15.8%), nuclear ventriculogram (12.8% vs 4.1%), exercise tolerance test (21.5% vs 3.4), and Holter monitoring (5.4% vs 0%). (All p < .01.) Differences in utilization were greater for patients at lower risk of dying. The average cost of care was 20.8% higher in Wisconsin (p = .01); risk adjustment for clinical and other factors reduced this difference to 11.8%, but did not eliminate it (p = .04). CONCLUSIONS Patients with acute myocardial infarction vary in resource use as a function of clinical factors present at admission and occurring during the hospital stay; comparisons that do not take account of these factors may not discriminate well between providers who care for sicker patients and those who are inefficient. The greater use of resources for patients in Wisconsin is at least partially explained by differences in clinical characteristics that are not presently captured in administrative data.
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Affiliation(s)
- W Du
- Health Care Research Unit, Boston University School of Medicine, Mass, USA
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Friedman EH. Cardiac rehabilitation factors. J Gen Intern Med 1995; 10:355. [PMID: 7562130 DOI: 10.1007/bf02599960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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