Comparison of adjustment, activity, and tangible social support in men and women patients and their spouses during the six months post-myocardial infarction

Factors affecting hospital readmission rates following an acute coronary syndrome: A systematic review

Aim

To synthesise quantitative evidence on factors that impact hospital readmission rates following ACS with comorbidities.

Design

Systematic review and narrative synthesis.

Data sources

A search of eight electronic databases, including Embase, Medline, PsycINFO, Web of Science, CINAHL, Cochrane Library, Scopus and the Joanna Briggs Institute (JBI).

Review methods

The search strategy included keywords and MeSH terms to identify English language studies published between 2001 and 2020. The quality of included studies was assessed by two independent reviewers, using Joanna Briggs Institute (JBI) critical appraisal tools.

Results

Twenty‐four articles were included in the review. All cause 30‐day readmission rate was most frequently reported and ranged from 4.2% to 81%. Reported factors that were associated with readmission varied across studies from socio‐demographic, behavioural factors, comorbidity factors and cardiac factors. Findings from some of the studies were limited by data source, study designs and small sample size.

Conclusion

Strategies that integrate comprehensive discharge planning and individualised care planning to enhance behavioural support are related to a reduction in readmission rates. It is recommended that nurses are supported to influence discharge planning and lead the development of nurse‐led interventions to ensure discharge planning is both coordinated and person‐centred.

Sex Differences in the Presentation of Chronic Low Back Pain

Sex differences in 351 patients with chronic low back pain were examined. Biological, psychological, and psychosocial factors were considered. Sex differences in adaptive functioning were consistent with traditional gender roles. Significant interactions were found for sex and employment status, and sex and marital status. Retired women reported more pain and less activity than retired men. Retired men reported the least pain of any group. Outdoor work and social activities show opposite within-group patterns for men and women when stratifiedby employment status. Marriage was associated with more household work for women and less for men. The financial and social contexts of employment status and marriage are different for men and women. Results suggest the treatment of women with chronic low back pain requires attention to work in the home and the financial and social context of work outside the home.

Sex Differences in the Rate, Timing, and Principal Diagnoses of 30-Day Readmissions in Younger Patients with Acute Myocardial Infarction

BACKGROUND

Young women (<65 years) experience a 2- to 3-fold greater mortality risk than younger men after an acute myocardial infarction. However, it is unknown whether they are at higher risk for 30-day readmission, and if this association varies by age. We examined sex differences in the rate, timing, and principal diagnoses of 30-day readmissions, including the independent effect of sex following adjustment for confounders.

METHODS AND RESULTS

We included patients aged 18 to 64 years with a principal diagnosis of acute myocardial infarction. Data were used from the Healthcare Cost and Utilization Project-State Inpatient Database for California (07-09). Readmission diagnoses were categorized by using an aggregated version of the Centers for Medicare and Medicaid Services' Condition Categories, and readmission timing was determined from the day after discharge. Of 42,518 younger patients with acute myocardial infarction (26.4% female), 4775 (11.2%) had at least 1 readmission. The 30-day all-cause readmission rate was higher for women (15.5% versus 9.7%, P<0.0001). For both sexes, readmission risk was highest on days 2 to 4 after discharge and declined thereafter, and women were more likely to present with noncardiac diagnoses (44.4% versus 40.6%, P=0.01). Female sex was associated with a higher rate of 30-day readmission, which persisted after adjustment (hazard ratio, 1.22; 95% confidence interval, 1.15-1.30). There was no significant interaction between age and sex on readmission.

CONCLUSIONS

In comparison with men, younger women have a higher risk for readmission, even after the adjustment for confounders. The timing of 30-day readmission was similar in women and men, and both sexes were susceptible to a wide range of causes for readmission.

Women with coronary artery disease and depression: a neglected risk group

Coronary artery disease (CAD) has been held to be a "male" disease due to men's higher absolute risk compared to women, but the relative risk of women for CAD morbidity and mortality is actually higher. The purpose of this article is to review research evidence for gender differences in CAD and depression with special emphasis on women. Current knowledge points to important gender differences in age of onset, symptom presentation, management, outcome as well as traditional and psychosocial risk factors. Compared to men, CAD risk in women is more strongly increased by some traditional factors (diabetes, hypertension, hypercholesterolemia, obesity), and socioeconomic and psychosocial factors seem to have a higher impact on CAD in women as well. With respect to differences in CAD management, a gender-bias in favour of men has to be taken into account in spite of older age and higher comorbidity in women, possibly contributing to a poorer outcome. Depression was shown to be an independent risk factor and consequence of CAD; however, concerning gender differences, the results have been inconsistent. Current evidence suggests that depression causes a greater increase in CAD incidence in women, and that female CAD patients experience higher levels of depression than men. Gender aspects should be more intensively considered both in further research on gender differences in comorbid depression and in cardiac treatment and rehabilitation with the goal of making secondary prevention for women more effective.

Gender differences in cardiovascular disease and comorbid depression

Although gender is increasingly perceived as a key determinant in health and illness, systematic gender studies in medicine are still lacking. For a long time, cardiovascular disease (CVD) has been seen as a “male” disease, due to men's higher absolute risk compared with women, but the relative risk in women of CVD morbidity and mortality is actually higher: Current knowledge points to important gender differences in age of onset, symptom presentation, management, and outcome, as well as traditional and psychosocial risk factors. Compared with men, CVD risk in women is increased to a greater extent by some traditional factors (eg, diabetes, hypertension, hypercholesterolemia, obesity,) and socioeconomic and psychosocial factors also seem to have a higher impact on CVD in women. With respect la differences in CVD management, a gender bias in favor of men has to be taken into account, in spite of greater age and higher comorbidity in women, possibly contributing to a poorer outcome. Depression has been shown to be an independent risk factor and consequence of CVD; however, concerning gender differences, The results have been inconsistent. Current evidence suggests that depression causes a greater increase in CVD incidence in women, and that female CVD patients experience higher levels of depression than men. Gensier aspects should be more intensively considered, both in further research on gender differences in comorbid depresion, and in cardiac treatment and rehabilitation, with the goal of making secondary prevention more effective.

Self-efficacy and overprotection are related to quality of life, psychological well-being and self-management in cardiac patients

This repeated-measures study explores how self-efficacy and overprotection relate to psychological well-being, health-related quality of life and self-management. Eighty-two cardiac patients, suffering from congestive heart failure (CHF) or myocardial infarction (MI), completed questionnaires at T1 and three months later. Perceived overprotection is associated with concurrent levels of anxiety and depression, and lowered quality of life. Self-efficacy is related to psychological well-being in both patient groups, but only associated with quality of life in CHF patients. In addition, self-efficacy predicts MI patients' self-management behaviours in the medium term. Findings have implications for cardiac rehabilitation, where attention may usefully be focused on enhancing self-efficacy and dealing with issues of support and overprotection by the partner.

Religion, relationships and mental health in midlife women following acute myocardial infarction

Little is known about coping in women following an acute myocardial infarction (AMI). In midlife, women have worse outcomes than men following AMI. Innovative interventions need to be developed that respond to these women's unique recovery needs. In this correlational, descriptive study, 59 women aged 35-64 who had experienced AMI reported low satisfaction with life and decreased mental health; 49% were experiencing depression. However, they also reported that religion, family, and friends provided strength and comfort at the time of their AMI. Greater activation of simple, family-oriented, coping resources during recovery may be key. It is recommended that mental health nurses be essential members of the recovery planning team.

Gender and Nutrition Management in Type 2 Diabetes

Purpose: The literature suggests that adherence to dietary recommendations may differ between women and men with type 2 diabetes due to family obligations and spousal support.

Methods: To assess division of household labour between spouses, retrospective chart review of 561 individuals who attended the Diabetes Education Centre at the Toronto Western Hospital was performed. Qualitative interviews were also performed with 12 married clients (six female and six male) and seven spouses of clients (three female, four male) to understand how the sharing of household labour influences adherence to nutrition guidelines in type 2 diabetes.

Results: Results indicate a significant gender difference in responsibility for meal preparation (χ2(3)=140.64, p<.001) and grocery shopping (χ2(3)=88.24, p<0.001), with women more often engaging in these household activities than men. Male clients are more likely to be actively supported by their wives in the form of meal preparation and verbal encouragement, while female clients are only passively supported by their husbands.

Conclusions: The results suggest that diabetes educators should recognize gender differences in household labour and support when counselling their clients to ensure that both men and women have the help they need to successfully manage their diabetes.

Gender and perceived severity of cardiac disease: evidence that women are "tougher"

PURPOSE

Patients' beliefs about their disease may affect their willingness to engage in preventive health behaviors. We sought to determine whether men and women with acute coronary syndrome differ in their perceptions of the severity of cardiac-related illness while controlling for the clinical severity of their condition.

METHODS

All patients with acute coronary syndrome discharged from a university hospital during a 3-year period were mailed a questionnaire, and medical records were abstracted. The questionnaire assessed perceived severity of cardiac-related illness (5-point scale from "very mild" to "very severe"), symptom frequency, type of acute coronary syndrome event, number of medications, Duke Activity Status Index (DASI), time since most recent cardiac event, Charlson Comorbidity Index, and demographic information. A logistic regression model was constructed with perceived severity of heart disease as the dependent variable. Gender was the key independent variable while controlling for the other patient and disease variables.

RESULTS

The 490 respondents (1217 surveys sent, 40.3% response rate) included 348 men and 142 women who were similar with regard to race and type of acute coronary syndrome event experienced. Women were older, less educated, had a lower DASI score, had more symptoms, and were taking more medications. However, they perceived their cardiac disease as being no more severe than the men. The significant predictors in the regression model of perceived severity included gender, DASI, number of symptoms, type of acute coronary syndrome event, and comorbidity. Female gender was associated with lower perceived severity (odds ratio 0.30-0.80).

CONCLUSIONS

Women rate their cardiac disease as less severe than do men when controlling for other measures of cardiac disease severity.

Myocardial infarction: gender differences in coping and social support

AIM

The aim of this review is to summarize current knowledge about gender differences in perceptions of coping and social support among patients who have experienced myocardial infarction.

RATIONALE

Women with coronary heart disease have physical, social and medical disadvantages compared with their male counterparts, which can influence their perception of recovery after cardiac events. No review has been found which focuses on gender differences in coping and social support in myocardial infarction patients.

METHOD

A computerized search was conducted using the keywords 'myocardial infarction', 'coping', 'gender differences' and 'social support'. Forty-one articles, published between 1990 and October 2002, were scrutinized.

FINDINGS

Two studies report that women used more coping strategies than men. Several qualitative studies found that women used a variety of coping strategies. Women minimized the impact of the disease, tended to delay in seeking treatment and did not want to bother others with their health problems. Household activities were important to them and aided their recovery. Men were more likely to involve their spouses in their recovery, and resuming work and keeping physically fit were important to them. Women tended to report that they had less social support up to 1 year after a myocardial infarction compared with men. They received less information about the disease and rehabilitation and experienced lack of belief in their heart problems from caregivers. Further, they received less assistance with household duties from informal caregivers. Men tended to report more support from their spouses than did women.

CONCLUSIONS

Traditional gender-role patterns may influence the recovery of patients who have experienced myocardial infarction. Caregivers may need to be more sensitive to gender-specific needs with regard to risk profiles, social roles, and the patient's own role identity. For many women, especially older ones, household duties and family responsibilities may be an opportunity and a base for cardiac rehabilitation.

How do female and male cardiac patients and their spouses share responsibilities after discharge from the hospital?

This study explored sex differences in household and employment responsibilities among cardiac patients (N = 63; 46 men) and spouses during the 5 months following discharge from the hospital. Results showed that both patients and partners maintained traditional sex-typed activities. As patients or spouses, women tended to assume greater responsibility for domestic tasks such as laundry, cleaning, and cooking than their husbands. Men as patients or spouses tended to assume greater responsibility for household repair and maintenance tasks. Husbands also worked more for pay outside the home than did wives, except in couples where the male patient was high risk. Correlations for male patients indicated that reports of more cardiac symptoms were associated with assuming fewer responsibilities. In contrast, among women, the correlations between symptoms and activities were more complex and suggested that female patients might not be heeding signs of overexertion.

A comparison of physical activity in men and women with cardiac disease: do gender roles complicate recovery?

Fifty-four male and twenty-six female married cardiac patients were studied for five months post-hospital discharge. Participants completed activity diaries for three days at 5, 10, 15, and 20 weeks. Reported activities were converted to METs. Patients increased activity across the five-month study period. Patients also tended to engage in higher levels of activity in the morning hours. Men and women did not differ in average total METs expended. Comparisons for specific activities indicated that women consistently expended more energy on domestic responsibilities, such as cleaning and laundry. Men engaged more in repairs, yardwork and carrying, but these activities were performed sporadically and involved low METs requirements. The concentrated domestic activity assumed by women early in recovery may pose a risk of complications.

Long-term mental health of men after a first acute myocardial infarction

OBJECTIVE

To evaluate the differential and independent impact of sociodemographic, medical, and psychologic variables assessed at hospital discharge on patients' short- and long-term mental health.

DESIGN

Longitudinal study.

SETTING

Eight medical centers in central Israel.

PARTICIPANTS

Male Israeli patients (N = 209; age range: 30-65 y) with documented first acute myocardial infarction (AMI).

INTERVENTION

Subjects were interviewed 3 times, once (T1) before hospital discharge, a second time (T2) at 3 to 6 months after discharge, and a third time (T3) at 5 years post-AMI. Sociodemographic, medical, and psychologic data were elicited at the first interview and completed with medical information in the files. Psychologic well-being and psychologic distress were evaluated by the Mental Health Inventory at the second and third interviews. These 2 outcome variables were compared with normative community data on these aspects of mental health.

MAIN OUTCOME MEASURES

Hierarchical regression was used to examine the relation between the independent variables, sociodemographic, medical, and psychologic variables, and the dependent variables, psychologic well-being and psychologic distress, at T2 and T3.

RESULTS

Depression, perceived health, sense of coherence, social support, and educational level at discharge predicted aspects of mental health 3 to 6 months and 5 years post-AMI. However, only psychologic distress differentiated between the research participants and the normative community sample of men.

CONCLUSIONS

A first episode of AMI appears to increase psychologic distress more than it decreases psychologic well-being both 3 to 6 months and 5 years post-AMI. Educational level and sense of coherence may serve as protective factors, whereas depression may foster vulnerability to distress and impaired psychologic well-being.

Psychosocial characteristics after acute myocardial infarction: the ENRICHD pilot study. Enhancing Recovery in Coronary Heart Disease

PURPOSE

Psychosocial factors, such as emotional distress and social isolation, have been increasingly recognized as important risk factors for patients' recovery from acute myocardial infarction (AMI). This study examined age, gender, and ethnic differences in depression and general distress, social support, and health-related quality of life after AMI.

METHODS

Data came from a series of 88 patients aged 62.1 +/- 14.2 years (46% female) who were hospitalized for AMI at eight different US clinical centers participating in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Pilot Study. Standardized psychometric measures were administered to assess three psychosocial domains: (1) depression and general distress (mental health functioning), (2) social support, and (3) health-related quality of life. Multivariate analysis of variance was used to examine the effects of age, gender, and ethnic differences in each of the three psychosocial domains.

RESULTS

Female patients reported higher levels of depression and distress compared with male patients (P = .040). Gender differences in mental health functioning differed by age (P = .046), with the greatest differences observed among younger female patients. Older patients (P = .014) and female patients (P = .025) reported lower levels of social support compared with younger and male patients, respectively. Minority patients did not differ from nonminority patients in mental health functioning or social support, and there were no significant differences in post-AMI quality of life on the basis of age, gender, or ethnicity.

CONCLUSIONS

The psychosocial risk profile after AMI may be different for male and female patients, and interventions may need to take account of each gender's specific needs.

Emotional and functional outcomes in women with coronary heart disease

Instruments used to measure emotional and functional outcomes of coronary heart disease show a fairly high level of consistency. Scores on depression scales are typically higher in women than men, yet this finding must be balanced with data showing that mean scores for depression are low. Both sexes report moderate levels of anxiety after a cardiac event; however, global mental health is rated as relatively high. Women report lower levels of physical activity and higher levels of disruption in functional activities than men. Women also report resuming household activities early in their recovery, a finding most likely reflective of traditional role responsibilities. Last, for both sexes, emotional distress and functional disability decrease over time and appear to be stable by 6 months after the event.

Psychosocial adjustment in patients after a first acute myocardial infarction: the contribution of salutogenic and pathogenic variables. Israel Study Group on First Acute Myocardial Infarction

OBJECTIVE

To ascertain the differential and independent impact of sociodemographic, medical, and psychologic variables assessed at patients' hospital discharge on these patients' psychosocial adjustment in several domains of life 3 to 6 months later.

DESIGN

Two-hundred ninety Israeli male patients, aged 30 to 65 years, with a documented first acute myocardial infarction (AMI) were interviewed once before discharge and again 3 to 6 months postinfarct. Sociodemographic, medical, and psychologic data were elicited at the first interview and completed from medical information in the hospital files. Psychosocial adjustment in seven significant life domains was evaluated by the Psychosocial Adjustment to Illness Scale-Self-Report Version (PAIS-SR) at the second interview. Hierarchical regression analysis was used to examine the relation between the sociodemographic, medical, and psychologic variables at discharge to psychosocial adjustment in the different life domains 3 to 6 months later.

RESULTS

Psychologic variables, such as depression, sense of coherence, and social support, and the sociodemographic variable of educational level at discharge predicted a relatively substantial amount of variance in psychosocial adjustment in most PAIS-SR-measured life domains. Low to moderate relations were found between such medical variables as Killip class, heart disease before AMI, other medical conditions, and perceived health before first AMI and psychosocial adjustment in specific life domains. The results also raised the possibility that part of the impact of the medical variables at discharge on psychosocial adjustment 3 to 6 months later may have been mediated by the psychologic variables. The centrality of the psychologic and domestic life domains to psychosocial adjustment in post-AMI patients was also suggested by the results.

CONCLUSIONS

Both external and internal pathogenic (depression) and health proneness variables (sense of coherence and social support) at discharge predict psychosocial adjustment in most life domains 3 to 6 months after AMI.