Understanding smoking after acute illness: An application of the sentinel event method

The influence of cognitive and affective components of the sentinel event on alcohol use following a brief intervention with trauma patients

OBJECTIVE

Alcohol-related injury is a sentinel event, an unanticipated medical event that may prompt a re-evaluation of health behaviors, such as alcohol use. Few studies have examined the psychological components of the sentinel event that motivate behavior change. In the present study, we examined the influence of cognitive and affective components of an alcohol-related injury on changes in alcohol use following a brief intervention.

METHOD

Injured patients (n = 411) who were drinking prior to their injury admission were recruited from three urban Level I trauma centers and randomized to receive brief advice or brief motivational intervention with or without a 1-month booster session. Assessments were completed at baseline and 3-, 6-, and 12-month follow-ups. Three groups were created based on endorsement (yes/no) of items assessing cognitive and affective components of the injury event: neither component, the cognitive component only, and both the cognitive and affective components.

RESULTS

Mixed-effects models indicated that participants who endorsed both the cognitive and affective components had greater reductions in peak alcohol use from baseline to 3-month follow-up than those who did endorsed neither component. By contrast, participants who endorsed the cognitive component, but not the affective component, had greater increases in average drinks per week and percentage of days of heavy drinking from 3- to 12-month follow-ups than those who endorsed neither component.

CONCLUSION

These results provide preliminary support for further consideration of an affective component of alcohol-related injuries that may motivate subsequent reductions in drinking following a sentinel event.

Modeling Health Event Impact on Smoking Cessation

Background

This study examined how cognitive and affective constructs related to an acute health event predict smoking relapse following an acute cardiac health event.

Methods

Participants were recruited from emergency departments and completed cognitive and emotional measures at enrollment and ecological momentary assessments (EMA) for 84 days postvisit.

Results

Of 394 participants, only 35 (8.9%) remained abstinent 84 days postvisit. Time to relapse was positively associated with age, actual illness severity, self-efficacy, and quit intentions.

Conclusions

Older, seriously ill patients with strong confidence and intentions to quit smoking remain abstinent longer after discharge, but most still relapse within three months.

It's Not Too Late to Improve Statin Adherence: Association Between Changes in Statin Adherence from Before to After Acute Myocardial Infarction and All-Cause Mortality

Background Many older patients have a change in statin adherence-either an increase or a decrease-from before to after an acute myocardial infarction ( AMI ), but its association with mortality is unknown. Methods and Results Using Medicare administrative claims, a cohort of patients ≥66 years old with an AMI hospitalization from 2008 to 2010 was assembled. Statin adherence was measured for 180 days pre- AMI and 180 days post- AMI and categorized as severely nonadherent, moderately nonadherent, or adherent. Categorical change in statin adherence from pre- to post- AMI was assessed. Patients were then followed for up to 18 months for all-cause mortality. A Cox proportional hazards model was applied to estimate the effects of statin adherence change on all-cause mortality, adjusted for patient baseline characteristics. Of 101 011 eligible patients, 20% had a categorical increase in adherence, 16% decreased, and 14% remained nonadherent both pre- and post- AMI . Compared with patients who were always severely nonadherent (both pre- and post- AMI ), patients whose adherence increased from severely nonadherent to adherent (hazard ratio=0.83; 95% CI : 0.75-0.92) and patients who were always adherent (hazard ratio=0.88; 95% CI : 0.82-0.94) were less likely to die; patients whose adherence decreased from moderately nonadherent to severely nonadherent were more likely to die (hazard ratio=1.11; 95% CI : 1.01-1.22). Conclusions After an AMI , patients with decreased statin adherence had the worst mortality outcomes. However, patients with increased statin adherence had a similar risk of mortality compared with continuously adherent patients, suggesting that, even after an AMI , it is not too late to improve statin adherence.

Changes in Statin Adherence Following an Acute Myocardial Infarction Among Older Adults: Patient Predictors and the Association With Follow-Up With Primary Care Providers and/or Cardiologists

BACKGROUND

Hospitalizations for acute myocardial infarctions (AMIs) are associated with changes in statin adherence. It is unclear to what extent adherence changes, which patients are likely to change, and how post-discharge follow-up is associated with statin adherence change.

METHODS AND RESULTS

This retrospective study used Medicare data for all fee-for-service beneficiaries 66 years and older with an AMI hospitalization in 2008-2010 and statin use before their index AMI. Multivariable multinomial logistic regression models (odds ratio [OR] and 99% confidence interval [CI]) were applied to assess associations between both patient characteristics and follow-up with a primary care provider and/or cardiologist with the outcome of statin adherence change (increase or decrease) from the 6-month pre- to 6-month post-AMI periods. Of 113 296 patients, 64.0% had no change in adherence, while 19.7% had increased and 16.3% had decreased adherence after AMI hospitalization. Black and Hispanic patients were more likely to have either increased or decreased adherence than white patients. Patients who required coronary artery bypass graft surgery (OR, 1.34; 99% CI, 1.21-1.49) or percutaneous transluminal coronary angioplasty/stent procedure (OR, 1.25; 99% CI, 1.17-1.32) during their index hospitalization were more likely to have increased adherence. Follow-up with a primary care provider was only mildly associated with increased adherence (OR, 1.08; 99% CI, 1.00-1.16), while follow-up with a cardiologist (OR, 1.15; 99% CI, 1.05-1.25) or both provider types (OR, 1.21; 99% CI, 1.12-1.30) had stronger associations with increased adherence.

CONCLUSIONS

Post-AMI changes in statin adherence varied by patient characteristics, and improved adherence was associated with post-discharge follow-up care, particularly with a cardiologist or both a primary care provider and a cardiologist.