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Agarwal MA, Ziaeian B. Cardiovascular Disease's Lonely Hearts Club. Am J Cardiol 2024; 211:360-362. [PMID: 37951331 PMCID: PMC10972543 DOI: 10.1016/j.amjcard.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/13/2023]
Affiliation(s)
- Manyoo A Agarwal
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | - Boback Ziaeian
- Division of Cardiovascular Medicine, University of California Los Angeles, Los Angeles, California
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Jiang Y, Yang JG, Qian HY, Yang YJ. Association between living alone and all-cause mortality of young and middle-aged patients with acute myocardial infarction: analysis of the China Acute Myocardial Infarction (CAMI) registry. BMC Public Health 2024; 24:14. [PMID: 38166780 PMCID: PMC10759749 DOI: 10.1186/s12889-023-17486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Lack of social support is a known predictor of the prognosis after acute myocardial infarction (AMI). Although as a common factor associated with social support, there are limited data on long-term prognostic impact of living status in young and middle-aged patients with AMI. METHODS We analyzed data from the China Acute Myocardial Infarction (CAMI) Registry, consecutive AMI young and middle-aged patients admitted at 108 hospitals in China between January 2013 and September 2014 were included. Eligible patients were assigned to living alone and not living alone groups based on their living status. The primary endpoint was 2-year all-cause mortality. The secondary endpoints included in-hospital mortality and 2-year major adverse cardiac and cerebrovascular events (MACCEs; a composite of all-cause mortality, MI, or stroke). Multilevel logistic and multilevel Cox regression models were used to evaluate the effect of living status on short-term and long-term outcomes. RESULTS A total of 8307 consecutive AMI young and middle-aged patients were included, 192 (2.3%) patients were living alone. Of the analyzed patients, living alone was associated with 2-year all-cause mortality and MACCEs among all analyzed patients after multivariate adjustment (adjusted hazard ratio [HR] = 2.171 [1.210-3.895], P = 0.009; adjusted HR = 2.169 [1.395-3.370], P = 0.001), but not with poorer in-hospital mortality. CONCLUSIONS The analysis suggested that living alone was associated with both 2-year all-cause mortality and MACCEs in AMI young and middle-aged patients but did not show an extra effect on the in-hospital mortality after covariate adjustment. TRIAL REGISTRATION Trial registration number: NCT01874691; Registered 31 October 2012.
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Affiliation(s)
- Yu Jiang
- Center for Coronary Heart Disease, Department of Cardiology, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China
| | - Jin-Gang Yang
- Center for Coronary Heart Disease, Department of Cardiology, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China
| | - Hai-Yan Qian
- Center for Coronary Heart Disease, Department of Cardiology, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China.
| | - Yue-Jin Yang
- Center for Coronary Heart Disease, Department of Cardiology, National Center for Cardiovascular Diseases of China, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China.
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Shibata Y, Kobayashi N, Shirakabe A, Miyauchi Y, Asai K. Comparisons of Patients Living Alone versus Living with Others in Acute Coronary Syndrome. Int J Angiol 2023; 32:179-187. [PMID: 37576535 PMCID: PMC10421695 DOI: 10.1055/s-0043-1767697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
We aimed to examine the relationship of living arrangements (i.e., living alone or living with others) with background, clinical severity, preintervention culprit lesion plaque morphology, and clinical outcomes in patients with acute coronary syndrome (ACS). Among 1,683 consecutive patients with ACS, we retrospectively compared patients living alone ( n = 318) versus living with others ( n = 1,362). Optical coherence tomography (OCT) findings, which are high-resolution intracoronary imaging devices, were analyzed in patients with preintervention OCT and compared between patients living alone ( n = 174) versus those living with others ( n = 665). Older (median; 69 vs. 67 y, p = 0.046) and female (31 vs. 17%, p < 0.001) patients more frequently lived alone. Frequency of achieving a time interval of 6 hours or less from ACS onset to admission was lower in patients living alone (56 vs. 63%, p = 0.022). Clinical presentation was more severe in patients living alone (Killip II/III/IV; 27 vs. 22%, p = 0.029). Plaque morphology evaluated by OCT was similar between groups (plaque rapture; 48 vs. 48%, p = 0.171). Kaplan-Meier analyses revealed higher rates of cardiac mortality during 2-year follow-up period in patients living alone [13.9 vs. 8.5%, hazard ratio (HR) 1.604, 95% confidence interval (CI) 1.112-2.313, p = 0.010]. After traditional cardiovascular risk factors and clinical severity upon admission had been adjusted, living alone was an independent predictor of cardiac mortality in ACS patients (HR 1.582, 95% CI 1.056-2.371, p = 0.026). Living alone was independently associated with 2-year cardiacmortality in ACS patients after adjusting for background and presentation and might be unrelated to the development of atherosclerosis.
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Affiliation(s)
- Yusaku Shibata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Nobuaki Kobayashi
- Cardiovascular Center, Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Yasushi Miyauchi
- Cardiovascular Center, Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kuniya Asai
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
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Loneliness, Social Isolation, and Living Alone Associations With Mortality Risk in Individuals Living With Cardiovascular Disease: A Systematic Review, Meta-Analysis, and Meta-Regression. Psychosom Med 2023; 85:8-17. [PMID: 36441849 DOI: 10.1097/psy.0000000000001151] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to conduct a systematic review and meta-analysis of associations between loneliness, social isolation, and living alone and risk of mortality among individuals with established cardiovascular disease. METHODS Five electronic databases were searched (MEDLINE [Ovid], PsycINFO, EMBASE, PubMed, and SCOPUS) from inception to November 25, 2021. In all, 35 studies were included in a narrative synthesis and, where appropriate, a meta-analytic evaluation using a random-effects model. RESULTS Living alone was associated with increased risk of all-cause mortality ( k = 15, n = 80,243, hazard ratio [HR] = 1.48, 95% confidence interval [CI] = 1.20-1.83, I2 = 83%), and meta-regressions found that the effects were stronger in studies from Europe and with longer follow-up. However, there was evidence of publication bias. Social isolation was associated with increased risk of all-cause mortality, measured both as a dichotomous variable ( k = 3, n = 2648, HR = 1.46, 95% CI = 1.08-2.04, I2 = 31%) and as a continuous variable ( k = 5, n = 2388, HR = 1.11, 95% CI = 1.02-1.24, I2 = 51%). Meta-analysis was not feasible for loneliness as exposure, but narrative synthesis of four studies suggested a tentative association between loneliness and increased risk of all-cause mortality. CONCLUSIONS Supporting public health concerns, our review finds that loneliness, social isolation, and living alone are associated with premature mortality among individuals with established cardiovascular disease. However, evidence of publication bias and large methodological differences across studies point to the need for more rigorous research.
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Isomatsu D, Sato A, Sakuma Y, Kurosawa Y, Muto Y, Sato Y, Kiko T, Shimizu T, Misaka T, Yoshihisa A, Yamaki T, Nakazato K, Ishida T, Takeishi Y. The Prognostic Implications of Living Alone on Long-Term Mortality in Patients with Chronic Coronary Syndrome after Percutaneous Coronary Intervention. Int Heart J 2023; 64:584-589. [PMID: 37518338 DOI: 10.1536/ihj.23-063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Living alone is associated with increased cardiac events and mortality in patients with acute myocardial infarction. However, the prognostic impact of living alone with chronic coronary syndrome (CCS) still remains unclear. In the present study, we examined the relationship between living alone and long-term mortality in patients with CCS who underwent percutaneous coronary intervention (PCI).Consecutive 830 patients with CCS who underwent PCI were enrolled and divided into 2 groups according to whether or not they were living alone at the time of admission (living alone group and non-living alone group). We compared the clinical characteristics between the 2 groups and followed up cardiac mortality. The living alone group was younger compared with the non-living alone group (67.5 versus 70.7 years old, P = 0.017). The prevalence of comorbidities, including coronary risk factors, atrial fibrillation, heart failure, stroke, peripheral artery disease, coronary lesion characteristics, laboratory data, and left ventricular ejection fraction, were comparable between the 2 groups. During the follow-up period (median 1,622 days), 52 cardiac deaths occurred. In the Kaplan-Meier analysis, cardiac mortality was significantly higher in the living alone group than in the non-living alone group (24% versus 11%, P = 0.008). In the multivariable Cox proportional hazard analyses after adjusting for possible confounding factors, living alone was an independent predictor of cardiac mortality (hazard ratio, 2.426, 95% confidence interval 1.225-4.804, P = 0.011).Among CCS patients who underwent PCI, living alone was associated with high long-term cardiac mortality.
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Affiliation(s)
- Daisuke Isomatsu
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Akihiko Sato
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Yuya Sakuma
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Yuta Kurosawa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Yuki Muto
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Yu Sato
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Takatoyo Kiko
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Takeshi Shimizu
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
- Department of Clinical Laboratory Sciences, Fukushima Medical University School of Health Science
| | - Takayoshi Yamaki
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Takafumi Ishida
- Department of Cardiovascular Medicine, Fukushima Medical University
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Kähkönen O, Oikarinen A, Vähänikkilä H, Kyngäs H. Association between perceived health and adherence to treatment after percutaneous coronary intervention: A long-term follow-up study. J Adv Nurs 2022; 78:1653-1664. [PMID: 34636444 DOI: 10.1111/jan.15069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 06/16/2021] [Accepted: 09/26/2021] [Indexed: 12/17/2022]
Abstract
AIMS To identify associations between perceived health and treatment adherence six years after percutaneous coronary intervention. DESIGN A non-experimental descriptive long-term follow-up study. METHODS Baseline data (n = 416) were collected in 2013, with follow-up data collected in 2019 (n = 154), using the EuroQoL scale, EuroQoL visual analogue scale, and Adherence of Patients with Chronic Disease Instrument. Data were analysed using descriptive statistics and multivariate methods. RESULTS The average age of the 154 respondents was 68.5 years (SD 7.01), with a majority males (n = 118, 86.6%). Adherence to a healthy lifestyle, good perceived results of care, support from nurses, high sense of normality, low fear of complications, motivation, older age, and duration of coronary artery disease were associated with better general perceived health as well as its dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). CONCLUSION Support from nurses is a key factor to ensuring high perceived health among post-percutaneous coronary intervention patients. This support must be continuous and motivate the patient to adhere to a healthy lifestyle. Patients should feel comfortable sharing their problems and fears. This type of relationship will allow health care professionals to assess the patient's current situation and address potential problems about mobility, pain and discomfort, as well as anxiety and depression to strengthen the patient's sense of normality and enable them to confidently lead a normal life. IMPACT The research aimed to gain knowledge about how perceived health is associated with treatment adherence six years after percutaneous coronary intervention. The results emphasise that a nurse's support of patients is crucial to the care process, as adherence to treatment showed a clear positive association with perceived health in the analysed sample of post-PCI patients.
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Affiliation(s)
- Outi Kähkönen
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu (MRC Oulu), Oulu, Finland
| | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu (MRC Oulu), Oulu, Finland
| | - Hannu Vähänikkilä
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure of Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu (MRC Oulu), Oulu, Finland.,Oulu University Hospital, Oulu, Finland
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Lloyd T, Crellin E, Brine RJ, Shen JY, Wolters AT. Association between household context and emergency hospital use in older people: a retrospective cohort study on indicators for people living alone or living with somebody with frailty, developed from routine healthcare data in England. BMJ Open 2022; 12:e059371. [PMID: 35501076 PMCID: PMC9062795 DOI: 10.1136/bmjopen-2021-059371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To derive two household context factors - living alone and living in a two-person household with a person who is frail - from routine administrative health data and to assess their association with emergency hospital use in people aged 65 or over. DESIGN Retrospective cohort study using national pseudonymised hospital data and pseudonymised address data derived from a minimised version of the Master Patient Index, a central database of all patient registrations in England. SETTING England-wide. PARTICIPANTS 4 876 285 people aged 65 years or older registered at GP practices in England on 16 December 2018 who were living alone or in a household of up to six people, and with at least one hospital admission in the last 3 years. OUTCOMES Rates of accident and emergency (A&E) attendance and inpatient emergency admissions over a 1-year follow-up period. RESULTS Older people living alone had higher rates of A&E attendances (adjusted rate ratio 1.09, 95% CI 1.09 to 1.10) and emergency admissions (1.14, 95% CI 1.14 to 1.15) than older people living in households of 2-6 people. Older people living with someone with frailty in a two-person household had higher rates of A&E attendance (adjusted rate ratio 1.09, 95% CI 1.08 to 1.10) and emergency admissions (1.10, 95% CI 1.09 to 1.11) than other older people living in a two-person household. CONCLUSIONS We show that household context factors can be derived from linked routine administrative health data and that these are strongly associated with higher emergency hospital use in older people. Using household context factors can improve analyses, as well as support in the understanding of local population needs and in population health management.
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Affiliation(s)
- Therese Lloyd
- Improvement Analytics Unit, The Health Foundation, London, UK
| | | | | | - Julia Y Shen
- Improvement Analytics Unit, The Health Foundation, London, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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Shah SJ, Fang MC, Wannier SR, Steinman MA, Covinsky KE. Association of Social Support With Functional Outcomes in Older Adults Who Live Alone. JAMA Intern Med 2022; 182:26-32. [PMID: 34779818 PMCID: PMC8593829 DOI: 10.1001/jamainternmed.2021.6588] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IMPORTANCE Older adults who live alone are at risk for poor health outcomes. Whether social support mitigates the risk of living alone, particularly when facing a sudden change in health, has not been adequately reported. OBJECTIVE To assess if identifiable support buffers the vulnerability of a health shock while living alone. DESIGN, SETTING, AND PARTICIPANTS In this longitudinal, prospective, nationally representative cohort study from the Health and Retirement Study (enrollment March 2006 to April 2015), 4772 community-dwelling older adults 65 years or older who lived alone in the community and could complete activities of daily living (ADLs) and instrumental ADLs independently were followed up biennially through April 2018. Statistical analysis was completed from May 2020 to March 2021. EXPOSURES Identifiable support (ie, can the participant identify a relative/friend who could help with personal care if needed), health shock (ie, hospitalization, new diagnosis of cancer, stroke, heart attack), and interaction (multiplicative and additive) between the 2 exposures. MAIN OUTCOMES AND MEASURES The primary outcomes were incident ADL dependency, prolonged nursing home stay (≥30 days), and death. RESULTS Of 4772 older adults (median [IQR] age, 73 [68-81] years; 3398 [71%] women) who lived alone, at baseline, 1813 (38%) could not identify support, and 3013 (63%) experienced a health shock during the study. Support was associated with a lower risk of a prolonged nursing home stay at 2 years (predicted probability, 6.7% vs 5.2%; P = .002). Absent a health shock, support was not associated with a prolonged nursing home stay (predicted probability over 2 years, 1.9% vs 1.4%; P = .21). However, in the presence of a health shock, support was associated with a lower risk of a prolonged nursing home stay (predicted probability over 2 years, 14.2% vs 10.9%; P = .002). Support was not associated with incident ADL dependence or death. CONCLUSIONS AND RELEVANCE In this longitudinal cohort study among older adults who live alone, identifiable support was associated with a lower risk of a prolonged nursing home stay in the setting of a health shock.
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Affiliation(s)
- Sachin J Shah
- Division of Hospital Medicine, University of California, San Francisco
| | - Margaret C Fang
- Division of Hospital Medicine, University of California, San Francisco
| | - S Rae Wannier
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Michael A Steinman
- Division of Geriatrics, University of California, San Francisco, San Francisco VA Medical Center
| | - Kenneth E Covinsky
- Division of Geriatrics, University of California, San Francisco, San Francisco VA Medical Center.,Associate Editor, JAMA Internal Medicine
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Ahn YE, Koh CK. Effects of Living Alone and Sedentary Behavior on Quality of Life in Patients With Multimorbidities: A Secondary Analysis of Cross-Sectional Survey Data Obtained From the National Community Database. J Nurs Res 2021; 29:e173. [PMID: 34313607 DOI: 10.1097/jnr.0000000000000448] [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: 11/25/2022] Open
Abstract
BACKGROUND Having multimorbidities may increase health problems. Moreover, health-related quality of life correlates negatively with the number of chronic conditions a patient has. Living alone has been identified as a predictor of poorer quality of life, and a sedentary lifestyle is widely known to increase health problems and mortality. PURPOSE This study was designed to identify the effects of living alone and of sedentary behavior on health-related quality of life in patients with multimorbidities using nationally representative community data. METHODS A secondary data analysis of the Korea National Health and Nutrition Examination Survey was conducted. In this study, 1,725 adult patients aged 19 years and above with two or more chronic diseases were selected for the analysis. Health-related quality of life was measured using the European Quality of Life-5 Dimensions. Multiple logistic regression was performed to identify the effects of living alone and of sedentary behavior on health-related quality of life. The statistical analyses took into account the components of the complex sampling design such as the strata, clusters, weights, and adjustment procedures, and missing data were treated in a valid manner. RESULTS After adjusting for gender, age, employment status, and number of chronic diseases, it was found that the odds of having a high health-related quality of life were lower in single households than in multiperson households (odds ratio = 0.62, 95% confidence interval [0.46, 0.84]). In addition, after adjusting for gender, age, employment status, number of chronic diseases, and living arrangement, the odds of having a high health-related quality of life decreased as sedentary time increased (odds ratio = 0.93, 95% confidence interval [0.89, 0.96]). CONCLUSIONS/IMPLICATIONS FOR PRACTICE To improve quality of life in patients with multimorbidities, nursing interventions that support patients who live alone and have complicated disease-related issues and that reduce sedentary behavior should be developed.
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Affiliation(s)
- Young Eun Ahn
- MSN, RN, Doctoral Student, College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Chin Kang Koh
- PhD, RN, Associate Professor, College of Nursing, The Research Institute of Nursing Research, Seoul National University, Seoul, Republic of Korea
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Lamesgin Endalew H, Liyew B, Kassew T, Ewnetu Tarekegn G, Dejen Tilahun A, Sewunet Alamneh T. Health-Related Quality of Life Among Myocardial Infarction Survivors: Structural Equation Modeling Approach. J Multidiscip Healthc 2021; 14:1543-1552. [PMID: 34188481 PMCID: PMC8235930 DOI: 10.2147/jmdh.s296064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/09/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Myocardial infarction is the fifth leading causes of disability-adjusted life years in low-income countries including Ethiopia. The aim of this study was to construct a hypothetical model to determine the factors affecting the health-related quality of life of myocardial infarction survivors at the cardiac center Ethiopia. METHODS A cross-sectional study design was employed, and 421 myocardial infarction patients were enrolled through consecutive sampling technique from the outpatient clinic at the cardiac center of Ethiopia. The World Health Organization Quality of Life-BREF-26 tool was used to assess the problem. It consists of four domains such as physical, psychological, social relationships, and environmental health domains. The structural equation modeling (SEM) analysis was employed using STATA-14 software to examine the relationship between various exogenous and endogenous or mediating variables with overall quality of life. RESULTS Psychological, physical, environmental health domains and sex had significant association with health-related quality of life (β=0.708, p<0.001, β= 0.237, p=0.046, β=0.242, p=0.020, and β=0.189, p=0.017, respectively), whereas age had direct, negative association with health-related quality of life (β=-0.007, p=0.026). Residence and level of education were not directly associated with health-related quality of life. Residence indirectly, negatively influenced health-related quality of life (β= -0.379, p<0.001). On the other hand, level of education indirectly, positively affects health-related quality of life (β=i0.133, p<0.001). CONCLUSION Psychological health factors had the most substantial causal effect on health-related quality of life, which was larger than the causal effects of physical and environmental health-related factors. Developing and providing comprehensive interventions are necessary to assess and manage psychological, physical, and environmental health factors and to improve the quality of life in myocardial infarction patients.
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Affiliation(s)
- Helen Lamesgin Endalew
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bikis Liyew
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tilahun Kassew
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gebrekidan Ewnetu Tarekegn
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ambaye Dejen Tilahun
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfa Sewunet Alamneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ansari MS, Alok AK, Jain D, Rana S, Gupta S, Salwan R, Venkatesh S. Predictive Model Based on Health Data Analysis for Risk of Readmission in Disease-Specific Cohorts. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2021; 18:1j. [PMID: 34035791 PMCID: PMC8120669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Intervention planning to reduce 30-day readmission post-acute myocardial infarction (AMI) in an environment of resource scarcity can be improved by readmission prediction score. The aim of study is to derive and validate a prediction model based on routinely collected hospital data for identification of risk factors for all-cause readmission within zero to 30 days post discharge from AMI. METHODS Our study includes 2,849 AMI patient records (January 2005 to December 2014) from a tertiary care facility in India. EMR with ICD-10 diagnosis, admission, pathological, procedural and medication data is used for model building. Model performance is analyzed for different combination of feature groups and diabetes sub-cohort. The derived models are evaluated to identify risk factors for readmissions. RESULTS The derived model using all features has the highest discrimination in predicting readmission, with AUC as 0.62; (95 percent confidence interval) in internal validation with 70/30 split for derivation and validation. For the sub-cohort of diabetes patients (1359) the discrimination is slightly better with AUC 0.66; (95 percent CI;). Some of the positively associated predictive variables, include age group 80-90, medicine class administered during index admission (Anti-ischemic drugs, Alpha 1 blocker, Xanthine oxidase inhibitors), additional procedure in index admission (Dialysis). While some of the negatively associated predictive variables, include patient demography (Male gender), medicine class administered during index admission (Betablocker, Anticoagulant, Platelet inhibitors, Anti-arrhythmic). CONCLUSIONS Routinely collected data in the hospital's clinical and administrative data repository can identify patients at high risk of readmission following AMI, potentially improving AMI readmission rate.
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Takeuchi M, Ogita M, Wada H, Takahashi D, Nozaki Y, Nishio R, Yasuda K, Takahashi N, Sonoda T, Yatsu S, Shitara J, Tsuboi S, Dohi T, Suwa S, Miyauchi K, Daida H. Comparison of long-term mortality between living alone patients vs. living together patients with acute coronary syndrome treated with percutaneous coronary intervention. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 6:332-337. [PMID: 32044997 DOI: 10.1093/ehjqcco/qcaa011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/24/2020] [Accepted: 02/01/2020] [Indexed: 02/06/2023]
Abstract
AIMS Living alone is reported as an independent risk factor for cardiovascular disease. However, little is known about the association between clinical outcomes and living alone in patients with acute coronary syndrome (ACS). The aim of this study was to determine whether living alone is an independent prognostic risk factor for long-term mortality stratified by age in patients with ACS who were treated with primary percutaneous coronary intervention (PCI). METHODS AND RESULTS We conducted an observational cohort study of ACS patients who underwent PCI between January 1999 and May 2015 at Juntendo University Shizuoka Hospital, Japan. The primary endpoint was all-cause death. Among 2547 ACS patients, 381 (15.0%) patients were living alone at the onset of ACS. The cumulative incidence of all-cause death was comparable between living alone and living together (34.8% vs. 34.4%, log-rank P = 0.63). However, among younger population (aged <65 years), the incidence of all-cause death was significantly higher in the living alone group (log-rank P = 0.01). Multivariate Cox hazard analysis revealed a significant association between living alone and all-cause death, even after adjusting for other risk factors (hazard ratio 2.30, 95% confidence interval 1.38-3.84, P = 0.001). CONCLUSION Although living alone was not significantly associated with long-term clinical outcomes in patients with ACS, it was a predictive risk factor among younger ACS patients. Careful attention should be paid to patients' lifestyle, especially younger patients with ACS.
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Affiliation(s)
- Mitsuhiro Takeuchi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Manabu Ogita
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Daigo Takahashi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Yui Nozaki
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Ryota Nishio
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Kentaro Yasuda
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Norihito Takahashi
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku Tokyo 113-8421, Japan
| | - Taketo Sonoda
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Shoichiro Yatsu
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Shuta Tsuboi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku Tokyo 113-8421, Japan
| | - Satoru Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku Tokyo 113-8421, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku Tokyo 113-8421, Japan
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Wright RS, Murphy JG. Homeless With a Heart Attack in America-A Double Whammy. Mayo Clin Proc 2020; 95:626-628. [PMID: 32200978 DOI: 10.1016/j.mayocp.2020.02.022] [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] [Received: 02/14/2020] [Accepted: 02/21/2020] [Indexed: 11/16/2022]
Affiliation(s)
- R Scott Wright
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| | - Joseph G Murphy
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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14
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Green YS, Hajduk AM, Song X, Krumholz HM, Sinha SK, Chaudhry SI. Usefulness of Social Support in Older Adults After Hospitalization for Acute Myocardial Infarction (from the SILVER-AMI Study). Am J Cardiol 2020; 125:313-319. [PMID: 31787249 DOI: 10.1016/j.amjcard.2019.10.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 01/14/2023]
Abstract
The availability of social support is associated with health outcomes after acute myocardial infarction (AMI), yet previous studies have largely considered social support as a single entity, rather than examining its discrete domains. Furthermore, few studies have investigated the impact of social support in older AMI patients, in whom it may be especially important. We aimed to determine the associations between 5 discrete domains of social support - emotional support, informational support, tangible support, positive social interaction, and affectionate support - with 6-month readmission and mortality in older patients hospitalized for AMI, adjusting for known predictors of post-AMI outcomes. Three thousand six participants 75 years and older were recruited from a network of 94 hospitals across the United States. A 5-item version of the Medical Outcomes Study Social Support Survey was used to measure perceived social support, and readmission and mortality were ascertained 6 months after initial hospitalization. Independent associations were determined using multivariable regression. Among 3,006 participants, mean age was 82 years, 44% were female, and 11% non-white. Participants who were female, non-white, less educated, and lived alone tended to report lower social support. In multivariable analyses, low informational support was associated with readmission (odds ratio 1.22; 95% confidence interval 1.01 to 1.47), and low emotional support with mortality (odds ratio 1.43; 95% confidence interval 1.04 to 1.97). In conclusion, individual domains of social support had distinct, independent associations with post-AMI outcomes, lending a more nuanced and precise understanding of this important social determinant of health. Understanding these distinct associations can inform the development of interventions and policies to improve post-AMI outcomes.
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Affiliation(s)
- Yaakov S Green
- Yale University School of Medicine, New Haven, Connecticut
| | - Alexandra M Hajduk
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
| | - Xuemei Song
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Samir K Sinha
- Departments of Medicine, Family and Community Medicine, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sarwat I Chaudhry
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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15
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Coughlin SS, Young L. Social Determinants of Myocardial Infarction Risk and Survival: A Systematic Review. EUROPEAN JOURNAL OF CARDIOVASCULAR RESEARCH 2020; 1:10.31487/j.ejcr.2020.01.02. [PMID: 33089252 PMCID: PMC7575212 DOI: 10.31487/j.ejcr.2020.01.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Social determinants of health that have been examined in relation to myocardial infarction incidence and survival include socioeconomic status (income, education), neighbourhood disadvantage, immigration status, social support, and social network. Other social determinants of health include geographic factors such as neighbourhood access to health services. Socioeconomic factors influence risk of myocardial infarction. Myocardial infarction incidence rates tend to be inversely associated with socioeconomic status. In addition, studies have shown that low socioeconomic status is associated with increased risk of poorer survival. There are well-documented disparities in myocardial infarction survival by socioeconomic status, race, education, and census-tract-level poverty. The results of this review indicate that social determinants such as neighbourhood disadvantage, immigration status, lack of social support, and social isolation also play an important role in myocardial infarction risk and survival. To address these social determinants and eliminate disparities, effective interventions are needed that account for the social and environmental contexts in which heart attack patients live and are treated.
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Affiliation(s)
- Steven S. Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia
- Correspondence to: Dr. Steven Coughlin, Ph.D., M.P.H., Professor, Department of Population Health Sciences, Medical College of Georgia, Institute of Public and Preventive Health, Augusta University, 1120 15th Street, 30912, Augusta, Georgia;
| | - Lufei Young
- College of Nursing, Augusta University, Augusta, Georgia
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16
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Christensen AV, Juel K, Ekholm O, Thrysøe L, Thorup CB, Borregaard B, Mols RE, Rasmussen TB, Berg SK. Significantly increased risk of all-cause mortality among cardiac patients feeling lonely. Heart 2019; 106:140-146. [PMID: 31685646 DOI: 10.1136/heartjnl-2019-315460] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To explore whether living alone and loneliness 1) are associated with poor patient-reported outcomes at hospital discharge and 2) predict cardiac events and mortality 1 year after hospital discharge in women and men with ischaemic heart disease, arrhythmia, heart failure or heart valve disease. METHODS A national cross-sectional survey including patients with known cardiac disease at hospital discharge combined with national register data at baseline and 1-year follow-up. Loneliness was evaluated using one self-reported question, and information on cohabitation was available from national registers. Patient-reported outcomes were Short Form-12, Hospital Anxiety and Depression Scale and HeartQoL. Clinical outcomes were 1-year cardiac events (myocardial infarction, stroke, cardiac arrest, ventricular tachycardia/fibrillation) and all-cause mortality from national registers. RESULTS A total of 13 443 patients (53%) with ischaemic heart disease, arrhythmia, heart failure or heart valve disease completed the survey. Of these, 70% were male, and mean age was 66.1 among women and 64.9 among men. Across cardiac diagnoses, loneliness was associated with significantly poorer patient-reported outcomes in men and women. Loneliness predicted all-cause mortality among women and men (HR 2.92 (95% CI 1.55 to 5.49) and HR 2.14 (95% CI 1.43 to 3.22), respectively). Living alone predicted cardiac events in men only (HR 1.39 (95% CI 1.05 to 1.85)). CONCLUSIONS A strong association between loneliness and poor patient-reported outcomes and 1-year mortality was found in both men and women across cardiac diagnoses. The results suggest that loneliness should be a priority for public health initiatives, and should also be included in clinical risk assessment in cardiac patients.
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Affiliation(s)
- Anne Vinggaard Christensen
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Thrysøe
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology and Department of Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Britt Borregaard
- Cardiothoracic and Vascular Department, Odense University Hospital, Odense, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Selina Kikkenborg Berg
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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17
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Mubanga M, Byberg L, Egenvall A, Ingelsson E, Fall T. Dog Ownership and Survival After a Major Cardiovascular Event: A Register-Based Prospective Study. Circ Cardiovasc Qual Outcomes 2019; 12:e005342. [PMID: 31592725 DOI: 10.1161/circoutcomes.118.005342] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dog ownership is associated with increased physical activity levels and increased social support, both of which could improve the outcome after a major cardiovascular event. Dog ownership may be particularly important in single-occupancy households where ownership provides substitutive companionship and motivation for physical activity. METHODS AND RESULTS We used the Swedish National Patient Register to identify all patients aged 40 to 85 presenting with an acute myocardial infarction (n=181 696; 5.7% dog ownership) or ischemic stroke (n=154 617; 4.8% dog ownership) between January 1, 2001 and December 31, 2012. Individual information was linked across registers for cause of death, sociodemographic, and dog ownership data. We evaluated all-cause mortality and risk of recurrent hospitalization for the same cause until December 31, 2012. Models were adjusted for socioeconomic, health, and demographic factors at study inclusion such as age, marital status, the presence of children in the home, area of residence, and income, as well as all registered comorbidities and hospitalization for cardiovascular disease in the past 5 years. Dog owners had a lower risk of death after hospitalization for acute myocardial infarction during the full follow-up period of 804 137 person-years, with an adjusted hazard ratio (HR) of 0.67 (95% CI, 0.61 to 0.75) for those who lived alone, and HR of 0.85 (95% CI, 0.80 to 0.90) for those living with a partner or a child. Similarly, after an ischemic stroke, dog owners were at lower risk of death during the full follow-up of 638 219 person-years adjusted HR of 0.73 (95% CI, 0.66 to 0.80) for those who lived alone and HR of 0.88 (95% CI, 0.83 to 0.93) for those living with a partner or a child. We further found an association of dog ownership with reduced risk of hospitalization for recurrent myocardial infarction (HR, 0.93; 95% CI, 0.87 to 0.99). CONCLUSIONS We found evidence of an association of dog ownership with a better outcome after a major cardiovascular event. Although our models are adjusted for many potential confounders, there are also unmeasured confounders such as smoking that prevent us from drawing conclusions regarding a possible causal effect.
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Affiliation(s)
- Mwenya Mubanga
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (M.M., E.I., T.F.), Uppsala University, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Orthopedics (L.B.), Uppsala University, Sweden
| | - Agneta Egenvall
- Department of Clinical Sciences, Division of Ruminant Medicine and Veterinary Epidemiology, Swedish University of Agricultural Sciences, Uppsala, Sweden (A.E.)
| | - Erik Ingelsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (M.M., E.I., T.F.), Uppsala University, Sweden.,Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine (E.I.).,Stanford Cardiovascular Institute (E.I.), Stanford University, CA.,Stanford Diabetes Research Center (E.I.), Stanford University, CA
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (M.M., E.I., T.F.), Uppsala University, Sweden
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Longitudinal associations of stressful life events and social support deficits with later functioning in patients with acute coronary syndrome: Social factors for functioning in ACS. J Affect Disord 2019; 256:560-566. [PMID: 31280081 DOI: 10.1016/j.jad.2019.06.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/25/2019] [Accepted: 06/30/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND In this study we investigated associations between stressful life events (SLEs) and social support deficit (SSD), which we evaluated within 2 weeks of an acute coronary syndrome (ACS) episode, and changes in functioning, disability, and quality of life (QOL) over a 1-year follow-up period. METHOD In total, 1152 patients were recruited at baseline within 2 weeks of an ACS episode, and 828 were followed up for 1 year thereafter. The occurrence of SLEs was identified at baseline using the "List of Threatening Events", and the participants were categorized into absent or present SLE groups. The SSD was evaluated using the Social Support Scale and was dichotomatized into low or high SSD groups. We measured social and occupational functioning, disability, and quality of life (QoL) at both examinations. The associations between the baseline SLE and SSD with functional changes over 1 year were estimated using repeated-measures analyses of covariance with relevant covariates. RESULTS The presence of SLEs and high SSD at baseline independently predicted worsening of functional disability and QoL over the 1-year follow-up period, after adjustment. Moreover, the coexistence of both present SLE and high SSD indicates negative effects that are more severe on functional outcomes. CONCLUSIONS SLEs and SSD at an early phase of ACS predicted chronically poorer functioning and QoL outcomes. Preventive and therapeutic efforts should include strategies to identify and manage psychosocial risk factors in ACS patients.
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Abstract
Numerous factors impact patient recovery following an acute myocardial infarction (AMI). Negative emotional outcomes, such as learned helplessness, are predictors of mortality following AMI, though little is known about these relationships. The purpose of this study was to examine the relationships between social support and self-efficacy with learned helplessness in individuals post-AMI. Using a descriptive cross-sectional design, subjects with a diagnosed AMI within 12 months were recruited. Standardized instruments were used to evaluate social support and self-efficacy and their impact on learned helplessness. A statistically significant, direct relationship was found between social support and self-efficacy, and learned helplessness, suggesting that individuals with better social support and self-efficacy experience less learned helplessness within the first year following an AMI. In developing post-AMI treatment plans, health care staff need to consider encouraging a patient's supportive social network and self-efficacy as meaningful interventions against negative emotional outcomes.
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20
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Bahall M. Prevalence and associations of depression among patients with cardiac diseases in a public health institute in Trinidad and Tobago. BMC Psychiatry 2019; 19:4. [PMID: 30616551 PMCID: PMC6323684 DOI: 10.1186/s12888-018-1977-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 12/07/2018] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Psychosocial issues are major determinants as well as consequences of cardiovascular disease (CVD). This study sought to assess the prevalence and identify factors associated with depression among patients with cardiac disease in a public health institute in Trinidad and Tobago. METHODS A cross-sectional study was conducted with a convenience sample of 388 hospitalised, stable, adult patients with cardiac disease admitted in the only tertiary public health institute in South Trinidad. Patients were identified and interviewed 3 to 5 days after admission using a questionnaire comprising questions on demographic, medical, and lifestyle issues and the 9-item Patient Health Questionnaire (PHQ-9). RESULTS The prevalence of clinically significant depression (PHQ-9 > 9) among hospitalised patients with cardiac disease was 40.0%. However, the prevalence of non-minimal depression (PHQ-9 ≥ 5) in this study was 78.4%. It was greater among women (83.1%) than among men (72.9%). Non-minimal depression was associated with sex (p = 0.015), employment status (p = 0.007), hypertension (p = 0.017), stressful life (p ≤ 0.001), feelings of depression (p ≤ 0.001), regular exercise (p ≤ 0.001), and living alone (p = 0.006). Age, ethnicity, education level, income, or religious affiliations were not associated (p > 0.05) with depression. Participants diagnosed with depression commonly reported feeling tired (81.2%), having trouble sleeping (74.7%), and moving/speaking slowly (73.5%). Patients with self-claimed depression (past or current) were four times more likely to have depression and those with self-reported stress and loneliness were twice as likely to have depression. Employed patients and those who exercised regularly were approximately 50% less likely to have depression. CONCLUSIONS Clinical depression prevalence among hospitalised patients with cardiac disease was 40.0%. Approximately twice as many (78.4%) had non-minimal depression, with higher prevalence among women. Employment, sex, hypertension, stressful life, feelings of depression, regular exercise, and living alone were associated with non-minimal depression. Patients with self-claimed depression, stress, and those living alone had a much higher likelihood of having depression, while those who were employed and exercised regularly were approximately half as likely to have depression.
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Affiliation(s)
- Mandreker Bahall
- School of Medicine and Arthur Lok Jack Graduate School of Business, University of the West Indies, St. Augustine, House #57 LP 62, Calcutta Road Number 3, McBean, Couva Trinidad, Trinidad and Tobago.
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21
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Kim JM, Kim JW, Kang HJ, Bae KY, Kim SW, Shin IS, Hong YJ, Ahn Y, Jeong MH, Yoon JS. Suicidal Ideation Predicts Functioning and Quality of Life Over One Year after Acute Coronary Syndrome. Psychiatry Investig 2019; 16:65-70. [PMID: 30605996 PMCID: PMC6354040 DOI: 10.30773/pi.2018.10.22.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/22/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE This study investigated the associations of suicidal ideation (SI) evaluated within 2 weeks after an acute coronary syndrome (ACS) episode with functioning, disability, and quality of life (QOL) at a 1-year follow-up assessment. METHODS This study recruited 1152 consecutive patients within 2 weeks of a confirmed ACS episode; 828 of these patients who were followed up 1 year later comprised the study sample. SI was determined at baseline using the "suicidal thoughts" item of the MontgomeryÅsberg Depression Rating Scale. At both examinations, social and occupational functioning were measured by the Social and Occupational Functioning Assessment Scale (SOFAS), disability was estimated by World Health Organization Disability Assessment Schedule-12 (WHODAS-12), and QOL was assessed using the World Health Organization Quality of Life-Abbreviated form (WHOQOL-BREF). Baseline covariates included sociodemographic data, depression characteristics, cardiovascular risk factors, and current cardiac status. RESULTS SI at baseline was independently associated with less improved or decreased scores on the SOFAS, WHODAS-12, and WHOQOL-BREF over 1 year after adjusting for relevant covariates. CONCLUSION SI within 2 weeks of an ACS episode predicted poorer functioning and QOL at a 1-year follow-up assessment. Thus, the simple evaluation of SI in patients with recently developed ACS could be helpful in screening for functioning and QOL during the chronic phase of this disease.
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Affiliation(s)
- Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Kyung-Yeol Bae
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jin-Sang Yoon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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Kim HS, Kim HK, Kang KO, Kim YS. Determinants of health-related quality of life among outpatients with acute coronary artery disease after percutaneous coronary intervention. Jpn J Nurs Sci 2018; 16:3-16. [DOI: 10.1111/jjns.12209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 11/19/2017] [Accepted: 01/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Hee Sun Kim
- College of Nursing, Research Institute of Nursing Science; Chonbuk National University; Jeonju South Korea
| | - Hyun Kyung Kim
- College of Nursing, Research Institute of Nursing Science; Chonbuk National University; Jeonju South Korea
| | - Kyung Ok Kang
- Chonbuk National University Hospital; Jeonju South Korea
| | - Yi Sik Kim
- Division of Cardiology, Department of Internal Medicine; Chonbuk National University Hospital; Jeonju South Korea
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23
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Erqou S, Echouffo-Tcheugui JB, Kip KE, Aiyer A, Reis SE. Association of cumulative social risk with mortality and adverse cardiovascular disease outcomes. BMC Cardiovasc Disord 2017; 17:110. [PMID: 28482797 PMCID: PMC5422978 DOI: 10.1186/s12872-017-0539-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 04/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quantifying the cumulative effect of social risk factors on cardiovascular disease (CVD) risk can help to better understand the sources of disparities in health outcomes. METHOD AND RESULTS Data from the Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) study were used to create an index of cumulative social risk (CSR) and quantify its association with incident CVD and all-cause mortality. CSR was defined by assigning a score of 1 for the presence of each of 4 social factors: i) racial minority status (Black race), ii) single living status, iii) low income, and iv) low educational level. Hazard ratios (HRs) were computed using Cox-regression models, adjusted for CVD risk factors. Over a median follow-up period of 8.3 years, 127 incident events were observed. The incidence of the primary outcome for subgroups of participants with 0, 1, and ≥2 CSR scores was 5.31 (95% CI, 3.40-7.22), 10.32 (7.16-13.49) and 17.80 (12.94-22.67) per 1000 person-years, respectively. Individuals with CSR score of 1 had an adjusted HR of 1.85 (1.15-2.97) for incident primary outcomes, compared to those with score of 0. The corresponding HR for individuals with CSR score of 2 or more was 2.58 (1.60-4.17). CONCLUSION An accumulation of social risk factors independently increased the likelihood of CVD events and deaths in a cohort of White and Black individuals.
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Affiliation(s)
- Sebhat Erqou
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | | | - Kevin E. Kip
- College of Nursing, University of South Florida, Tampa, FL USA
| | - Aryan Aiyer
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Steven E. Reis
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
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Kang K, Gholizadeh L, Inglis SC, Han HR. Correlates of health-related quality of life in patients with myocardial infarction: A literature review. Int J Nurs Stud 2017; 73:1-16. [PMID: 28511032 DOI: 10.1016/j.ijnurstu.2017.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND By the increasing emphasis on health-related quality of life (HRQoL) in patients with myocardial infarction (MI), it is necessary to explore factors that affect HRQoL in this population. OBJECTIVES This study aimed to identify correlates of HRQoL in patients with MI. DESIGN A literature review of the factors that affect HRQoL in patients with MI (1995-2016). DATA SOURCES Three main databases-CINAHL, MEDLINE and PsychINFO-were searched to retrieve relevant peer-reviewed articles published in English. REVIEW METHODS In consultation with a medical librarian, we identified relevant MeSH terms and used them for searching the literature: health-related quality of life/quality of life/HRQoL/QoL, myocardial infarction/heart attack/MI and predict*/factor. Data elements were extracted and narratively described variables synthesised into four categories. RESULTS A total of 48 studies met the inclusion criteria and were included in the review. Correlates of HRQoL in patients with MI were identified in the following categories: demographic, behavioural, disease-related, and psychosocial factors. Specific correlates included age and gender-identity for demographic factors; physical activity and smoking for behavioural factors; severity of MI, symptoms, and comorbidities for disease-related factors; anxiety and depression for psychosocial factors. CONCLUSIONS Identifying correlates of HRQoL can help identify patients who are at risk for poor HRQoL in the recovery or rehabilitation stage of post-MI. Future intervention should focus on adjustable correlates such as behavioural and psychosocial factors to promote HRQoL among patients after experiencing MI.
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Affiliation(s)
- Kyoungrim Kang
- University of Technology Sydney, Sydney, NSW, Australia.
| | | | | | - Hae-Ra Han
- The Johns Hopkins University, Baltimore, MD, USA
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Horne BD, Budge D, Masica AL, Savitz LA, Benuzillo J, Cantu G, Bradshaw A, McCubrey RO, Bair TL, Roberts CA, Rasmusson KD, Alharethi R, Kfoury AG, James BC, Lappé DL. Early inpatient calculation of laboratory-based 30-day readmission risk scores empowers clinical risk modification during index hospitalization. Am Heart J 2017; 185:101-109. [PMID: 28267463 DOI: 10.1016/j.ahj.2016.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 12/22/2016] [Indexed: 11/19/2022]
Abstract
Improving 30-day readmission continues to be problematic for most hospitals. This study reports the creation and validation of sex-specific inpatient (i) heart failure (HF) risk scores using electronic data from the beginning of inpatient care for effective and efficient prediction of 30-day readmission risk. METHODS HF patients hospitalized at Intermountain Healthcare from 2005 to 2012 (derivation: n=6079; validation: n=2663) and Baylor Scott & White Health (North Region) from 2005 to 2013 (validation: n=5162) were studied. Sex-specific iHF scores were derived to predict post-hospitalization 30-day readmission using common HF laboratory measures and age. Risk scores adding social, morbidity, and treatment factors were also evaluated. RESULTS The iHF model for females utilized potassium, bicarbonate, blood urea nitrogen, red blood cell count, white blood cell count, and mean corpuscular hemoglobin concentration; for males, components were B-type natriuretic peptide, sodium, creatinine, hematocrit, red cell distribution width, and mean platelet volume. Among females, odds ratios (OR) were OR=1.99 for iHF tertile 3 vs. 1 (95% confidence interval [CI]=1.28, 3.08) for Intermountain validation (P-trend across tertiles=0.002) and OR=1.29 (CI=1.01, 1.66) for Baylor patients (P-trend=0.049). Among males, iHF had OR=1.95 (CI=1.33, 2.85) for tertile 3 vs. 1 in Intermountain (P-trend <0.001) and OR=2.03 (CI=1.52, 2.71) in Baylor (P-trend < 0.001). Expanded models using 182-183 variables had predictive abilities similar to iHF. CONCLUSIONS Sex-specific laboratory-based electronic health record-delivered iHF risk scores effectively predicted 30-day readmission among HF patients. Efficient to calculate and deliver to clinicians, recent clinical implementation of iHF scores suggest they are useful and useable for more precise clinical HF treatment.
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Affiliation(s)
- Benjamin D Horne
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT; Department of Biomedical Informatics, University of Utah, Salt Lake City, UT.
| | - Deborah Budge
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT
| | - Andrew L Masica
- Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, TX
| | - Lucy A Savitz
- Institute for Healthcare Leadership, Intermountain Healthcare, Salt Lake City, UT; Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | - José Benuzillo
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT; Institute for Healthcare Leadership, Intermountain Healthcare, Salt Lake City, UT
| | - Gabriela Cantu
- Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, TX
| | - Alejandra Bradshaw
- Institute for Healthcare Leadership, Intermountain Healthcare, Salt Lake City, UT
| | - Raymond O McCubrey
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT
| | - Tami L Bair
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT
| | - Colleen A Roberts
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT; Institute for Healthcare Leadership, Intermountain Healthcare, Salt Lake City, UT
| | - Kismet D Rasmusson
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT
| | - Rami Alharethi
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT
| | - Abdallah G Kfoury
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Brent C James
- Institute for Healthcare Leadership, Intermountain Healthcare, Salt Lake City, UT; Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | - Donald L Lappé
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT
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Kang K, Gholizadeh L, Inglis SC, Han HR. Interventions that improve health-related quality of life in patients with myocardial infarction. Qual Life Res 2016; 25:2725-2737. [PMID: 27592108 DOI: 10.1007/s11136-016-1401-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 01/07/2023]
Abstract
PURPOSE Patients with myocardial infarction (MI) often report lower health-related quality of life (HRQoL) than those without MI. Interventions can affect HRQoL of these patients. The purpose of this review was to identify effective strategies for improving HRQoL among individuals with MI. METHODS Three electronic databases were searched and limited to articles peer-reviewed and published in English between 1995 and 2015. We screened titles and abstracts of the retrieved articles for studies that examined effectiveness of interventions to improve HRQoL in patients with MI. RESULTS Twenty-three studies were found that examined the effects of behavioural interventions-cardiac rehabilitation programmes (CRP), education and counselling programmes, and other psychological and cognitive interventions-to improve HRQoL in patients with MI. The studies included were mainly randomised controlled trials (14 studies) with a wide age range of participants (18-80 years) and a mean age group of 50-70 years. CRPs, including home- and hospital-based CRPs, regular weekly aerobic training programmes, and group counselling mostly resulted in improvement of HRQoL in patients with MI. CONCLUSION Most CRPs and other interventions were beneficial to MI patients. Therefore, patients with MI should be encouraged to participate in programmes that can help promote their HRQoL.
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Affiliation(s)
| | | | | | - Hae-Ra Han
- Johns Hopkins University, Baltimore, MD, USA
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Spatz ES, Beckman AL, Wang Y, Desai NR, Krumholz HM. Geographic Variation in Trends and Disparities in Acute Myocardial Infarction Hospitalization and Mortality by Income Levels, 1999-2013. JAMA Cardiol 2016; 1:255-65. [PMID: 27438103 PMCID: PMC5459393 DOI: 10.1001/jamacardio.2016.0382] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE During the past decade, the incidence and mortality associated with acute myocardial infarction (AMI) in the United States have decreased substantially. However, it is unknown whether these improvements were consistent across communities of different economic status and geographic regions since efforts to improve cardiovascular disease prevention and management may have had variable impact. OBJECTIVE To determine whether trends in US county-level, risk-standardized AMI hospitalization and mortality rates varied by county-based median income level. DESIGN, SETTING, AND PARTICIPANTS In this observational study, county-level risk-standardized (age, sex, and race) hospitalization and 1-year mortality rates for AMI from January 1, 1999, to December 31, 2013, were measured for Medicare beneficiaries 65 years or older. Data analysis was performed from June 2 through December 1, 2015. Counties were stratified by median income percentile using 1999 US Census Bureau data adjusted for inflation: low- (<25th), average- (25th-75th), or high- (>75th) income groups. MAIN OUTCOMES AND MEASURES The effect of income on the slope of AMI hospitalizations and mortality, measured as differences in the rate of change in AMI hospitalizations and mortality by county income and by the 4 US geographic regions, and a possible lag effect among low-income counties. RESULTS In the 15-year study period, AMI risk-standardized hospitalization and mortality rates decreased significantly for all 3 county income groups. Mean hospitalization rates were significantly higher among low-income counties compared with high-income counties in 1999 (1353 vs 1123 per 100 000 person-years, respectively) and in 2013 (853 vs 648 per 100 000 person-years, respectively). One-year mortality rates after hospitalization for AMI were similar across county income groups, decreasing from 1999 (31.5%, 31.4%, and 31.1%, for high-, average-, and low-income counties, respectively) to 2013 (26.2%, 26.1%, and 25.4%, respectively). Income was associated with county-level, risk-standardized AMI hospitalization rates but not mortality rates. Increasing 1 interquartile range of median county consumer price index-adjusted income ($12 000) was associated with a decline in 46 and 37 hospitalizations per 100 000 person-years for 1999 and 2013, respectively; interaction between income and time was 0.56. The rate of decline in AMI hospitalizations was similar for all county income groups; however, low-income counties lagged behind high-income counties by 4.3 (95% CI, 3.1-5.9) years. There were no significant differences in trends across geographic regions. CONCLUSIONS AND RELEVANCE Hospitalization and mortality rates of AMI declined among counties of all income levels, although hospitalization rates among low-income counties lag behind those of the higher income groups. These findings lend support for a more targeted, community-based approach to AMI prevention.
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Affiliation(s)
- Erica S Spatz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut2Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | | | - Yun Wang
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut2Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut4Department of Biostatistics, Harva
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut2Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut2Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut5Department of Health Policy and Ma
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Hayes RM, Carter PR, Gollop ND, Uppal H, Sarma J, Chandran S, Potluri R. The impact of marital status on mortality and length of stay in patients admitted with acute coronary syndrome. Int J Cardiol 2016; 212:142-4. [DOI: 10.1016/j.ijcard.2016.03.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/16/2016] [Indexed: 11/26/2022]
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Gallagher J, Parenti G, Doyle F. Psychological Aspects of Cardiac Care and Rehabilitation: Time to Wake Up to Sleep? Curr Cardiol Rep 2015; 17:111. [DOI: 10.1007/s11886-015-0667-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Friedler B, Crapser J, McCullough L. One is the deadliest number: the detrimental effects of social isolation on cerebrovascular diseases and cognition. Acta Neuropathol 2015; 129:493-509. [PMID: 25537401 DOI: 10.1007/s00401-014-1377-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/14/2014] [Accepted: 12/17/2014] [Indexed: 12/27/2022]
Abstract
The deleterious effects of chronic social isolation (SI) have been recognized for several decades. Isolation is a major source of psychosocial stress and is associated with an increased prevalence of vascular and neurological diseases. In addition, isolation exacerbates morbidity and mortality following acute injuries such as stroke or myocardial infarction. In contrast, affiliative social interactions can improve organismal function and health. The molecular mechanisms underlying these effects are unknown. Recently, results from large epidemiological trials and pre-clinical studies have revealed several potential mediators of the detrimental effects of isolation. At least three major biological systems have been implicated: the neuroendocrine (HPA) axis, the immune system, and the autonomic nervous system. This review summarizes studies examining the relationship between isolation and mortality and the pathophysiological mechanisms underlying SI. Cardiovascular, cerebrovascular, and neurological diseases including atherosclerosis, myocardial infarction, ischemic stroke and Alzheimer's disease are given special emphasis in the context of SI. Sex differences are highlighted and studies are separated into clinical and basic science for clarity.
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Affiliation(s)
- Brett Friedler
- Department of Neuroscience, University of Connecticut Health Center, 263 Farmington Ave., Farmington, CT, 06030, USA,
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Ahn JH, Kim HK, Kim JY, Won J, Seo HW, Hong YJ, Kim JH, Jeong MH, Cho JG, Park JC, Cho SH, Ahn Y. The Impacts of Living Alone in in-Hospital and One-Year Clinical Outcomes after Acute Myocardial Infarction in Korean Patients. J Lipid Atheroscler 2015. [DOI: 10.12997/jla.2015.4.2.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Joon Ho Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Kuk Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Yoon Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jumin Won
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Hyeong Won Seo
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Sook Hee Cho
- Department of Nursing, Mokpo National University, Mokpo, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
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Reeves MJ, Prager M, Fang J, Stamplecoski M, Kapral MK. Impact of Living Alone on the Care and Outcomes of Patients With Acute Stroke. Stroke 2014; 45:3083-5. [DOI: 10.1161/strokeaha.114.006520] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Outcomes among patients living alone at stroke onset could be directly affected by reduced access to acute therapies or indirectly through the effects of social isolation. We examined the associations between living alone at home and acute stroke care and outcomes in the Registry of the Canadian Stroke Network.
Methods—
Between 2003 and 2008, 10 048 patients with acute stroke (87% ischemic, 13% hemorrhagic) who were living at home were admitted to 11 Ontario hospitals. Outcomes included arrival ≤2.5 hours of onset, thrombolytic treatment, discharge home, 30-day and 1-year mortality, and 1-year readmission. The effects of living alone versus living with others were determined using multivariable logistic regression.
Results—
Overall, 22.8% (n=2288) of patients were living alone at home before stroke. Subjects living alone were significantly older (mean, 74.6 versus 71.5 years), more likely to be women (61.5% versus 41.4%), widowed (53.7% versus 12.3%), or single (21.5% versus 3.8%). Patients living alone were less likely to arrive within 2.5 hours (28.3% versus 40.0%; adjusted odds ratio, 0.54; 95% confidence interval, 0.48–0.60), to receive thrombolysis (8.0% versus 14.0%; adjusted odds ratio, 0.52; 95% confidence interval, 0.43–0.63), or to be discharged home (46.0% versus 54.7%; adjusted odds ratio, 0.65; 95% confidence interval, 0.58–0.73). There were no significant associations between living alone and mortality or readmission.
Conclusions—
Patients living alone had delayed hospital arrival, less thrombolytic therapy, and were less likely to return home. Greater understanding of the inter-relationships among living alone, social isolation, access to stroke care, and outcomes is needed.
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Affiliation(s)
- Mathew J. Reeves
- From the Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Institute for Clinical Evaluation Sciences (ICES), Toronto, ON, Canada (M.P., J.F., M.S., M.K.K.); and Division of General Internal Medicine and Toronto General Research Institute, University Health Network, Toronto, ON, Canada (M.K.K.)
| | - Marla Prager
- From the Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Institute for Clinical Evaluation Sciences (ICES), Toronto, ON, Canada (M.P., J.F., M.S., M.K.K.); and Division of General Internal Medicine and Toronto General Research Institute, University Health Network, Toronto, ON, Canada (M.K.K.)
| | - Jiming Fang
- From the Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Institute for Clinical Evaluation Sciences (ICES), Toronto, ON, Canada (M.P., J.F., M.S., M.K.K.); and Division of General Internal Medicine and Toronto General Research Institute, University Health Network, Toronto, ON, Canada (M.K.K.)
| | - Melissa Stamplecoski
- From the Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Institute for Clinical Evaluation Sciences (ICES), Toronto, ON, Canada (M.P., J.F., M.S., M.K.K.); and Division of General Internal Medicine and Toronto General Research Institute, University Health Network, Toronto, ON, Canada (M.K.K.)
| | - Moira K. Kapral
- From the Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Institute for Clinical Evaluation Sciences (ICES), Toronto, ON, Canada (M.P., J.F., M.S., M.K.K.); and Division of General Internal Medicine and Toronto General Research Institute, University Health Network, Toronto, ON, Canada (M.K.K.)
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Bucholz EM, Strait KM, Dreyer RP, Geda M, Spatz ES, Bueno H, Lichtman JH, D'Onofrio G, Spertus JA, Krumholz HM. Effect of low perceived social support on health outcomes in young patients with acute myocardial infarction: results from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study. J Am Heart Assoc 2014; 3:e001252. [PMID: 25271209 PMCID: PMC4323798 DOI: 10.1161/jaha.114.001252] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Social support is an important predictor of health outcomes after acute myocardial infarction (AMI), but social support varies by sex and age. Differences in social support could account for sex differences in outcomes of young patients with AMI. Methods and Results Data from the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study, an observational study of AMI patients aged ≤55 years in the United States and Spain, were used for this study. Patients were categorized as having low versus moderate/high perceived social support using the ENRICHD Social Support Inventory. Outcomes included health status (Short Form‐12 physical and mental component scores), depressive symptoms (Patient Health Questionnaire), and angina‐related quality of life (Seattle Angina Questionnaire) evaluated at baseline and 12 months. Among 3432 patients, 21.2% were classified as having low social support. Men and women had comparable levels of social support at baseline. On average, patients with low social support reported lower functional status and quality of life and more depressive symptoms at baseline and 12 months post‐AMI. After multivariable adjustment, including baseline health status, low social support was associated with lower mental functioning, lower quality of life, and more depressive symptoms at 12 months (all P<0.001). The relationship between low social support and worse physical functioning was nonsignificant after adjustment (P=0.6). No interactions were observed between social support, sex, or country. Conclusion Lower social support is associated with worse health status and more depressive symptoms 12 months after AMI in both young men and women. Sex did not modify the effect of social support.
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Affiliation(s)
- Emily M Bucholz
- Yale University School of Medicine, New Haven, CT (E.M.B.) Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (E.M.B., J.H.L.)
| | - Kelly M Strait
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., M.G., E.S.S., H.M.K.)
| | - Rachel P Dreyer
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., M.G., E.S.S., H.M.K.)
| | - Mary Geda
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., M.G., E.S.S., H.M.K.)
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., M.G., E.S.S., H.M.K.) Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, Madrid, Spain (E.S.S., H.M.K.)
| | - Hector Bueno
- Department of Cardiology, Hospital General Universitario "Gregario Maraon", Madrid, Spain (H.B.)
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (E.M.B., J.H.L.)
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT (G.O.)
| | - John A Spertus
- Mid-America Heart Institute, University of Missouri-Kansas City Kansas City, MO (J.A.S.)
| | - Harlan M Krumholz
- Robert Wood Johnson Foundation Clinical Scholars Program, Departments of Internal Medicine and Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.) Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., M.G., E.S.S., H.M.K.) Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, Madrid, Spain (E.S.S., H.M.K.)
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Caleyachetty R, Echouffo-Tcheugui JB, Shimbo D, Zhu W, Muennig P. Cumulative social risk and risk of death from cardiovascular diseases and all-causes. Int J Cardiol 2014; 177:1106-7. [PMID: 25179557 DOI: 10.1016/j.ijcard.2014.08.088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 08/14/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Rishi Caleyachetty
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | | | - Daichi Shimbo
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Wenyi Zhu
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Peter Muennig
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA
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Comparison of long-term mortality after acute myocardial infarction treated by percutaneous coronary intervention in patients living alone versus not living alone at the time of hospitalization. Am J Cardiol 2014; 114:522-7. [PMID: 24998090 DOI: 10.1016/j.amjcard.2014.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/15/2014] [Accepted: 05/15/2014] [Indexed: 11/20/2022]
Abstract
Living alone was reported to be associated with increased risk of cardiovascular disease. There are, however, limited data on the relation between living alone and all-cause mortality in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). The Coronary REvascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) AMI registry was a cohort study of patients with AMI enrolled in 26 hospitals in Japan from 2005 through 2007. For the current analysis, we included those patients who underwent PCI within 24 hours of symptom onset, and we assessed their living status to determine if living alone would be an independent prognostic risk factor. Among 4,109 patients eligible for the current analysis of 5,429 patients enrolled in the CREDO-Kyoto AMI registry, 515 patients (12.5%) were living alone at the time of hospital admission. The cumulative 5-year incidence of all-cause death was 18.3% in the living alone group and 20.1% in the not living alone group (log-rank p = 0.77). After adjusting for potential confounders, risk of the living alone group relative to the not living alone group for all-cause death was not significantly different (adjusted hazard ratio 0.82, 95% confidence interval 0.65 to 1.02, p = 0.08). In a subgroup analysis stratified by age, the adjusted risk for all-cause death was also not different between the living alone group and the not living alone group both in the older population (aged ≥75 years) and the younger population (aged <75 years). In conclusion, living alone was not associated with higher long-term mortality in patients with AMI who underwent PCI.
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Gurland B, Teresi JA, Eimicke JP, Maurer MS, Reid MC. Quality of life impacts on 16-year survival of an older ethnically diverse cohort. Int J Geriatr Psychiatry 2014; 29:533-45. [PMID: 24167085 PMCID: PMC4372056 DOI: 10.1002/gps.4038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 09/23/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study is to examine the prediction of mortality, over 16 years, by the domains and domain elements underlying generic measures of quality of life (QoL). METHODS The method used was an analysis of mortality in an older (65 + years) representative sample (N = 2130) of a multicultural community in North Manhattan. Five conventional QoL domains were measured by in-home, rater-administered, and computer-assisted questionnaire: depressed mood, pain, self-perceived health, and function and social relationships. RESULTS Some domain scales that qualitatively express distress, such as depressed mood and widespread pain, significantly predicted lower mortality (were protective) and felt isolation trended in that direction, whereas domains indicating quantitative limitations such as impairment of functioning in daily tasks, stair climbing, as well as social disengagements and lack of support network significantly predicted higher mortality. Domain elements also mattered; contrary to their domain predictions, increased mortality was predicted by the domain elements of somatic symptoms of depression. Self-perceived poor health reflected the predictive (higher mortality) direction of the limitations cluster. CONCLUSIONS The internal complexity of QoL is underscored by differential impacts of domains and elements on mortality. Clinical implications include setting distress domains as important clinical goals, whereas strengthening limiting domains could result in lengthening life and secondarily relieving distress. The relative weighting of these goals could be derived from patient preferences and clinical efficacy. Fundamental implications lie in the interaction between the person's qualitative evaluations of choices and the quantitative building of desired choices for a better QoL.
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Affiliation(s)
- Barry Gurland
- Stroud Centre, Columbia University, New York, NY USA
| | | | | | - Mathew S. Maurer
- Department of Medicine, Division of Cardiology, Columbia University, New York, NY USA
| | - M. Carrington Reid
- Geriatrics and Gerontology, Weill Cornell Medical College, New York, NY USA
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Floud S, Balkwill A, Canoy D, Wright FL, Reeves GK, Green J, Beral V, Cairns BJ. Marital status and ischemic heart disease incidence and mortality in women: a large prospective study. BMC Med 2014; 12:42. [PMID: 24618083 PMCID: PMC4103700 DOI: 10.1186/1741-7015-12-42] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Being married has been associated with a lower mortality from ischemic heart disease (IHD) in men, but there is less evidence of an association for women, and it is unclear whether the associations with being married are similar for incident and for fatal IHD. We examined the relation between marital status and IHD incidence and mortality in the Million Women Study. METHODS A total of 734,626 women (mean age 60 years) without previous heart disease, stroke or cancer, were followed prospectively for hospital admissions and deaths. Adjusted relative risks (RRs) for IHD were calculated using Cox regression in women who were married or living with a partner versus women who were not. The role of 14 socio-economic, lifestyle and other potential confounding factors was investigated. RESULTS 81% of women reported being married or living with a partner and they were less likely to live in deprived areas, to smoke or be physically inactive, but had a higher alcohol intake than women who were not married or living with a partner. During 8.8 years of follow-up, 30,747 women had a first IHD event (hospital admission or death) and 2,148 died from IHD. Women who were married or living with a partner had a similar risk of a first IHD event as women who were not (RR = 0.99, 95% confidence interval (CI) 0.96 to 1.02), but a significantly lower risk of IHD mortality (RR = 0.72, 95% CI 0.66 to 0.80, P <0.0001). This lower risk of IHD death was evident both in women with and without a prior IHD hospital admission (respectively: RR = 0.72, 95% CI 0.60 to 0.85, P <0.0001, n = 683; and 0.70, 95% CI 0.62 to 0.78, P <0.0001, n = 1,465). These findings did not vary appreciably between women of different socio-economic groups or by lifestyle and other factors. CONCLUSIONS After adjustment for socioeconomic, lifestyle and other factors, women who were married or living with a partner had a similar risk of developing IHD but a substantially lower IHD mortality compared to women who were not married or living with a partner.
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Affiliation(s)
- Sarah Floud
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford OX3
7LF, UK
| | - Angela Balkwill
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford OX3
7LF, UK
| | - Dexter Canoy
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford OX3
7LF, UK
| | - F Lucy Wright
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford OX3
7LF, UK
| | - Gillian K Reeves
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford OX3
7LF, UK
| | - Jane Green
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford OX3
7LF, UK
| | - Valerie Beral
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford OX3
7LF, UK
| | - Benjamin J Cairns
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford OX3
7LF, UK
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Long-term prognostic significance of living alone and other risk factors in patients with acute myocardial infarction. Ir J Med Sci 2014; 184:153-8. [DOI: 10.1007/s11845-014-1079-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
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Quinones PA, Kirchberger I, Heier M, Kuch B, Trentinaglia I, Mielck A, Peters A, von Scheidt W, Meisinger C. Marital status shows a strong protective effect on long-term mortality among first acute myocardial infarction-survivors with diagnosed hyperlipidemia--findings from the MONICA/KORA myocardial infarction registry. BMC Public Health 2014; 14:98. [PMID: 24479754 PMCID: PMC3937149 DOI: 10.1186/1471-2458-14-98] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/25/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Reduction of long term mortality by marital status is well established in general populations. However, effects have been shown to change over time and differ considerably by cause of death. This study examined the effects of marital status on long term mortality after the first acute myocardial infarction. METHODS Data were retrieved from the population-based MONICA (Monitoring trends and determinants on cardiovascular diseases)/KORA (Cooperative Health Research in the Region of Augsburg)-myocardial infarction registry which assesses cases from the city of Augsburg and 2 adjacent districts located in southern Bavaria, Germany. A total of 3,766 men and women aged 28 to 74 years who were alive 28 days after their first myocardial infarction were included. Hazard ratios (HR) for the effects of marital status on mortality after one to 10 years of follow-up are presented. RESULTS The study population included 2,854 (75.8%) married individuals. During a median follow-up of 5.3 years, with an inter-quartile range of 3.3 to 7.6 years, 533 (14.15%) deaths occurred. Among married and unmarried individuals 388 (13.6%) and 145 (15.9%) deaths occurred, respectively. Overall marital status showed an insignificant protective HR of 0.76 (95% confidence interval (CI) 0.47-1.22). Stratified analyses revealed strong protective effects only among men and women younger than 60 who were diagnosed with hyperlipidemia. HRs ranged from 0.27 (95% CI 0.13-0.59) for a two-year survival to 0.43 (95% CI 0.27-0.68) for a 10-year survival. Substitution of marital status with co-habitation status confirmed the strata-specific effect [HR: 0.52 (95% CI 0.31-0.86)]. CONCLUSIONS Marital status has a strong protective effect among first myocardial infarction survivors with diagnosed hyperlipidemia, which diminishes with increasing age. Treatments, recommended lifestyle changes or other attributes specific to hyperlipidema may be underlying factors, mediated by the social support of spouses. Underlying causes should be examined in further studies.
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Affiliation(s)
- Philip Andrew Quinones
- Institute of Epidemiology II, Helmholtz-Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
| | - Inge Kirchberger
- Institute of Epidemiology II, Helmholtz-Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
| | - Margit Heier
- Institute of Epidemiology II, Helmholtz-Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
| | - Bernhard Kuch
- Department of Internal Medicine I, Central Hospital of Augsburg, Augsburg, Germany
- Department of Internal Medicine/Cardiology, Hospital of Nördlingen, Nördlingen, Germany
| | - Ines Trentinaglia
- Institute of Epidemiology II, Helmholtz-Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Andreas Mielck
- Institute of Health Economics and Health Care Management, Helmholtz-Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz-Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Wolfgang von Scheidt
- Department of Internal Medicine I, Central Hospital of Augsburg, Augsburg, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz-Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
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Rana S, Tran T, Luo W, Phung D, Kennedy RL, Venkatesh S. Predicting unplanned readmission after myocardial infarction from routinely collected administrative hospital data. AUST HEALTH REV 2014; 38:377-82. [DOI: 10.1071/ah14059] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 04/18/2014] [Indexed: 12/11/2022]
Abstract
Objective
Readmission rates are high following acute myocardial infarction (AMI), but risk stratification has proved difficult because known risk factors are only weakly predictive. In the present study, we applied hospital data to identify the risk of unplanned admission following AMI hospitalisations.
Methods
The study included 1660 consecutive AMI admissions. Predictive models were derived from 1107 randomly selected records and tested on the remaining 553 records. The electronic medical record (EMR) model was compared with a seven-factor predictive score known as the HOSPITAL score and a model derived from Elixhauser comorbidities. All models were evaluated for the ability to identify patients at high risk of 30-day ischaemic heart disease readmission and those at risk of all-cause readmission within 12 months following the initial AMI hospitalisation.
Results
The EMR model has higher discrimination than other models in predicting ischaemic heart disease readmissions (area under the curve (AUC) 0.78; 95% confidence interval (CI) 0.71–0.85 for 30-day readmission). The positive predictive value was significantly higher with the EMR model, which identifies cohorts that were up to threefold more likely to be readmitted. Factors associated with readmission included emergency department attendances, cardiac diagnoses and procedures, renal impairment and electrolyte disturbances. The EMR model also performed better than other models (AUC 0.72; 95% CI 0.66–0.78), and with greater positive predictive value, in identifying 12-month risk of all-cause readmission.
Conclusions
Routine hospital data can help identify patients at high risk of readmission following AMI. This could lead to decreased readmission rates by identifying patients suitable for targeted clinical interventions.
What is known about the topic?
Many clinical and demographic risk factors are known for hospital readmissions following acute myocardial infarction, including multivessel disease, high baseline heart rate, hypertension, diabetes, obesity, chronic obstructive pulmonary disease and psychiatric morbidity. However, combining these risk factors into indices for predicting readmission had limited success. A recent study reported a C-statistic of 0.73 for predicting 30-day readmissions. In a recent American study, a simple seven-factor score was shown to predict hospital readmissions among medical patients.
What does this paper add?
This paper presents a way to predict readmissions following myocardial infarction using routinely collected administrative data. The model performed better than the recently described HOSPITAL score and a model derived from Elixhauser comorbidities. Moreover, the model uses only data generally available in most hospitals.
What are the implications for practitioners?
Routine hospital data available at discharges can be used to tailor preventative care for AMI patients, to improve institutional performance and to decrease the cost burden associated with AMI.
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Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI, Barreto-Filho JA, Kim N, Suter LG, Bernheim SM, Drye EE, Krumholz HM. Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions. BMJ 2013; 347:f6571. [PMID: 24259033 PMCID: PMC3898430 DOI: 10.1136/bmj.f6571] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether high performing hospitals with low 30 day risk standardized readmission rates have a lower proportion of readmissions from specific diagnoses and time periods after admission or instead have a similar distribution of readmission diagnoses and timing to lower performing institutions. DESIGN Retrospective cohort study. SETTING Medicare beneficiaries in the United States. PARTICIPANTS Patients aged 65 and older who were readmitted within 30 days after hospital admission for heart failure, acute myocardial infarction, or pneumonia in 2007-09. MAIN OUTCOME MEASURES Readmission diagnoses were classified with a modified version of the Centers for Medicare and Medicaid Services' condition categories, and readmission timing was classified by day (0-30) after hospital discharge. Hospital 30 day risk standardized readmission rates over the three years of study were calculated with public reporting methods of the US federal government, and hospitals were categorized with bootstrap analysis as having high, average, or low readmission performance for each index condition. High and low performing hospitals had ≥ 95% probability of having an interval estimate respectively less than or greater than the national 30 day readmission rate over the three year period of study. All remaining hospitals were considered average performers. RESULTS For readmissions in the 30 days after the index admission, there were 320,003 after 1,291,211 admissions for heart failure (4041 hospitals), 102,536 after 517,827 admissions for acute myocardial infarction (2378 hospitals), and 208,438 after 1,135,932 admissions for pneumonia (4283 hospitals). The distribution of readmissions by diagnosis was similar across categories of hospital performance for all three conditions. High performing hospitals had fewer readmissions for all common diagnoses. Median time to readmission was similar by hospital performance for heart failure and acute myocardial infarction, though was 1.4 days longer among high versus low performing hospitals for pneumonia (P<0.001). Findings were unchanged after adjustment for other hospital characteristics potentially associated with readmission patterns. CONCLUSIONS High performing hospitals have proportionately fewer 30 day readmissions without differences in readmission diagnoses and timing, suggesting the possible benefit of strategies that lower risk of readmission globally rather than for specific diagnoses or time periods after hospital stay.
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Affiliation(s)
- Kumar Dharmarajan
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, 630 West 168th Street, Box 93, PH 10-203, New York, NY 10032, USA
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Glozier N, Tofler GH, Colquhoun DM, Bunker SJ, Clarke DM, Hare DL, Hickie IB, Tatoulis J, Thompson DR, Wilson A, Branagan MG. Psychosocial risk factors for coronary heart disease. Med J Aust 2013; 199:179-80. [PMID: 23909539 DOI: 10.5694/mja13.10440] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 07/07/2013] [Indexed: 11/17/2022]
Abstract
In 2003, the National Heart Foundation of Australia published a position statement on psychosocial risk factors and coronary heart disease (CHD). This consensus statement provides an updated review of the literature on psychosocial stressors, including chronic stressors (in particular, work stress), acute individual stressors and acute population stressors, to guide health professionals based on current evidence. It complements a separate updated statement on depression and CHD. Perceived chronic job strain and shift work are associated with a small absolute increased risk of developing CHD, but there is limited evidence regarding their effect on the prognosis of CHD. Evidence regarding a relationship between CHD and job (in)security, job satisfaction, working hours, effort-reward imbalance and job loss is inconclusive. Expert consensus is that workplace programs aimed at weight loss, exercise and other standard cardiovascular risk factors may have positive outcomes for these risk factors, but no evidence is available regarding the effect of such programs on the development of CHD. Social isolation after myocardial infarction (MI) is associated with an adverse prognosis. Expert consensus is that although measures to reduce social isolation are likely to produce positive psychosocial effects, it is unclear whether this would also improve CHD outcomes. Acute emotional stress may trigger MI or takotsubo ("stress") cardiomyopathy, but the absolute increase in transient risk from an individual stressor is low. Psychosocial stressors have an impact on CHD, but clinical significance and prevention require further study. Awareness of the potential for increased cardiovascular risk among populations exposed to natural disasters and other conditions of extreme stress may be useful for emergency services response planning. Wider public access to defibrillators should be available where large populations gather, such as sporting venues and airports, and as part of the response to natural and other disasters.
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Affiliation(s)
- Nick Glozier
- Brain and Mind Research Institute, University of Sydney, Sydney, NSW
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Pryor T, Page K, Patsamanis H, Jolly KA. Investigating support needs for people living with heart disease. J Clin Nurs 2013; 23:166-72. [DOI: 10.1111/jocn.12165] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 10/26/2022]
Affiliation(s)
- Tess Pryor
- Heart Foundation Victoria; Melbourne Vic. Australia
| | - Karen Page
- Heart Foundation Victoria; Melbourne Vic. Australia
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Kitamura T, Sakata Y, Nakatani D, Suna S, Usami M, Matsumoto S, Hara M, Hamasaki T, Nanto S, Sato H, Hori M, Iso H, Komuro I. Living alone and risk of cardiovascular events following discharge after acute myocardial infarction in Japan. J Cardiol 2013; 62:257-62. [PMID: 23778005 DOI: 10.1016/j.jjcc.2013.04.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/11/2013] [Accepted: 04/23/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known about the long-term risk of cardiovascular events after discharge among acute myocardial infarction (AMI) survivors living alone in Japan. METHODS AND RESULTS A large-scale prospective, observational study in the Osaka region involved consecutive patients with AMI from January 2002 through December 2010. We evaluated the association between living alone and longitudinal risk of cardiovascular events following discharge after AMI. A Cox proportional-hazards model was used to assess the association between living alone and the primary composite endpoint consisting of major adverse cardiovascular events and total deaths. During the study period, 5845 patients (4415 male patients, 1430 female patients) were registered. Living alone was found to be independently associated with a higher risk of composite endpoint consisting of major adverse cardiovascular events and total deaths [adjusted hazard ratio (HR) 1.32; 95% confidence interval (CI): 1.11-1.58]. Multivariate-adjusted HRs of composite endpoint were 1.34 (95% CI: 1.08-1.68) among male patients and 1.31 (95% CI: 0.95-1.81) in the female patients. AMI survivors living alone tend to have a higher adjusted HR of composite endpoint than those not living alone irrespective of age and gender groups. CONCLUSIONS From this large AMI registry in Osaka, AMI survivors living alone after discharge had a higher risk of cardiovascular events and total deaths than those not living alone.
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Affiliation(s)
- Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
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Green P, Newman JD, Shaffer JA, Davidson KW, Maurer MS, Schwartz JE. Relation of patients living without a partner or spouse to being physically active after acute coronary syndromes (from the PULSE accelerometry substudy). Am J Cardiol 2013; 111:1264-9. [PMID: 23411104 PMCID: PMC3640672 DOI: 10.1016/j.amjcard.2013.01.272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 12/22/2022]
Abstract
Living alone is associated with adverse outcomes after acute coronary syndromes (ACS). One potential mediator of the relation between partner status and outcomes after ACS is physical activity. To evaluate the association of partner status with physical activity after ACS, data from 107 participants enrolled in the Prescription Use, Lifestyle, and Stress Evaluation (PULSE) study, a prospective observational study of post-ACS patients, were analyzed. Accelerometers were used to measure physical activity after hospital discharge. The primary outcome measure was a maximum 10 hours of daytime activity 1 month after discharge. One month after discharge from ACS hospitalizations, participants without a partner or spouse exhibited 24.4% lower daytime activity than those with a partner or spouse (p = 0.003). After controlling for age, gender, body mass index, Charlson co-morbidity index, and traditional psychosocial and clinical cardiovascular correlates of post-ACS physical activity, partner status remained an independent predictor of post-ACS physical activity (20.5% lower daytime activity among those without a partner or spouse, p = 0.008). In conclusion, in this study of accelerometer-measured physical activity after an ACS hospitalization, those without a partner or spouse exhibit significantly less physical activity than those with a partner or spouse 1 month after discharge from the hospital. Low physical activity may be an important mediator of the prognosis associated with partner status after ACS.
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Affiliation(s)
- Philip Green
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
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