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Mols RE, Løgstrup BB, Bakos I, Horváth-Puhó E, Gustafsson F, Eiskjær H. Employment Status Following Heart Transplantation: Data From the Danish Nationwide Social Service Payment Register During 20 years. Transpl Int 2024; 37:12230. [PMID: 38694491 PMCID: PMC11061463 DOI: 10.3389/ti.2024.12230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/03/2024] [Indexed: 05/04/2024]
Abstract
Most studies on vocational rehabilitation after heart transplantation (HTX) are based on self-reported data. Danish registries include weekly longitudinal information on all public transfer payments. We intended to describe 20-year trends in employment status for the Danish heart-transplant recipients, and examine the influence of multimorbidity and socioeconomic position (SEP). Linking registry and Scandiatransplant data (1994-2018), we conducted a study in recipients of working age (19-63 years). The cohort contained 492 recipients (79% males) and the median (IQR) age was 52 years (43-57 years). Five years after HTX, 30% of the survived recipients participated on the labor market; 9% were in a flexible job with reduced health-related working capacity. Moreover, 60% were retired and 10% eligible for labor market participation were unemployed. Recipients with multimorbidity had a higher age and a lower prevalence of employment. Five years after HTX, characteristics of recipients with labor market participation were: living alone (27%) versus cohabitation (73%); low (36%) versus medium-high (64%) educational level; low (13%) or medium-high (87%) income group. Heart-transplant recipients with multimorbidity have a higher age and a lower prevalence of employment. Socioeconomically disadvantaged recipients had a lower prevalence of labor market participation, despite being younger compared with the socioeconomically advantaged.
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Affiliation(s)
- Rikke Elmose Mols
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Brian Bridal Løgstrup
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - István Bakos
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Hans Eiskjær
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Wagner MK, Christensen AV, Hassager C, Stenbæk DS, Ekholm O, Borregaard B, Thrysoee L, Rasmussen TB, Thorup CB, Mols RE, Juel K, Berg SK. Sex Differences in Patient-Reported Outcomes in the Immediate Recovery Period After Resuscitation: Findings From the Cross-sectional DenHeart Survey. J Cardiovasc Nurs 2023; 38:279-287. [PMID: 37027133 PMCID: PMC10090329 DOI: 10.1097/jcn.0000000000000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A paucity of resuscitation studies have examined sex differences in patient-reported outcomes upon hospital discharge. It remains unclear whether male and female patients differ in health outcomes in their immediate responses to trauma and treatment after resuscitation. OBJECTIVES The aim of this study was to examine sex differences in patient-reported outcomes in the immediate recovery period after resuscitation. METHODS In a national cross-sectional survey, patient-reported outcomes were measured by 5 instruments: symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), illness perception (Brief Illness Perception Questionnaire [B-IPQ]), symptom burden (Edmonton Symptom Assessment Scale [ESAS]), quality of life (Heart Quality of Life Questionnaire), and perceived health status (12-Item Short Form Survey). RESULTS Of 491 eligible survivors of cardiac arrest, 176 (80% male) participated. Compared with male, resuscitated female reported worse symptoms of anxiety (Hospital Anxiety and Depression Scale-Anxiety score ≥8) (43% vs 23%; P = .04), emotional responses (B-IPQ) (mean [SD], 4.9 [3.12] vs 3.7 [2.99]; P = .05), identity (B-IPQ) (mean [SD], 4.3 [3.10] vs 4.0 [2.85]; P = .04), fatigue (ESAS) (mean [SD], 5.26 [2.48] vs 3.92 [2.93]; P = .01), and depressive symptoms (ESAS) (mean [SD], 2.60 [2.68] vs 1.67 [2.19]; P = .05). CONCLUSIONS Between sexes, female survivors of cardiac arrest reported worse psychological distress and illness perception and higher symptom burden in the immediate recovery period after resuscitation. Attention should focus on early symptom screening at hospital discharge to identify those in need of targeted psychological support and rehabilitation.
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Nielsen MH, Rasmussen TB, Wagner MK, Bekker D, Bruvik SM, Ekholm O, Berg SK, Christensen AV, Mols RE, Thorup CB, Thrysoee L, Borregaard B. Return to work and everyday life following out-of-hospital cardiac arrest. Results from the national survey, DenHeart. Heart Lung 2023; 58:54-61. [PMID: 36402118 DOI: 10.1016/j.hrtlng.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND With increasing survival rates following out-of-hospital cardiac arrest (OHCA), knowledge on return to everyday life, including return to work, should be getting increasing attention. OBJECTIVES To i) describe patterns of labor market affiliation up to 12 months after discharge among a workforce population and to, ii) investigate the association between clinical and sociodemographic characteristics, self-reported health at discharge and a composite endpoint of prolonged sick leave and leaving the workforce after 3 and 12 months. METHODS Data from the national survey, DenHeart, were used, including measures of self-reported health: HeartQoL and the Hospital Anxiety and Depression Scale (HADS), combined with register-based follow-up. RESULTS During the study period, n = 572 OHCA patients were discharged from five Heart centres, n = 184 were part of the workforce. At discharge, 60% were on paid sick leave, and 20% at 12 months. Age (per one year older) increased the odds of experiencing the composite endpoint at 3 and 12 months (3 months: OR 1.06 95%CI 1.03-1.10, 12 months: OR 1.06 95%CI 1.03-1.09) among the total population (n = 184). Self-reported health at discharge was not associated with the endpoint. CONCLUSION One-fifth of the OHCA survivors at a working-age prior to the OHCA was still on paid sick leave after 12 months. Increasing age was the only characteristic associated with a composite endpoint of prolonged sick leave or leaving the workforce at 3 and 12 months after discharge. With increasing survival rates, healthcare professionals need to support the population in resuming daily life, including returning to the workforce, when relevant.
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Affiliation(s)
- Maiken Hedegaard Nielsen
- Department of Cardiology, Odense University Hospital, Odense Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mette Kirstine Wagner
- Department of Cardiology, Rigshospitalet, Copenhagen University hospital, Copenhagen, Denmark
| | - Ditte Bekker
- Department of Cardiology, Odense University Hospital, Odense Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Rigshospitalet, Copenhagen University hospital, Copenhagen, Denmark
| | | | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Brun Thorup
- Aalborg University Hospital, Department of Cardiology, Cardiothoracic surgery and Clinical Nursing Research Unit, Aalborg, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Odense Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.
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Kristiansen AM, Lönnberg H, Christensen B, Bridal Løgstrup B, Eiskjær H, Terkildsen Maindal H, Elmose Mols R. Experiences with cross-sectional healthcare and treatment in heart failure patients: implications for medical education. Int J Med Educ 2022; 13:345-362. [PMID: 36587398 PMCID: PMC10693395 DOI: 10.5116/ijme.6399.eef4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Objectives to explore how cross-sectional healthcare and treatment is experienced a) by patients with advanced heart failure and multimorbidity and b) by hospital-employed healthcare professionals. Methods Individual telephone interviews with 18 patients and close relatives were conducted. Furthermore, a focus group session was conducted with four specialised hospital-employed healthcare professionals. Purposeful sampling was used and interviews were semi-structured. Data were analysed using qualitative inductive content analysis. Results Three main themes emerged from the interviews with patients and close relatives. These included: 1) A need for improved coordination to ensure continuity of care; 2) a plea for patient-centred care; and 3) recognition of the need to care for close relatives. Analysis of the interviews with hospital-employed healthcare professionals also produced three themes. These concerned: 1) recognition of the role and needs of close relatives; 2) limited resources for and difficulties in meeting these needs; and 3) agreement on the need for patient-centred care. Furthermore, we learned that perceived challenges are rooted in time constraints and the need for an adequate level of medical knowledge of chronic conditions and complex treatment strategies. Conclusions This study indicates that cross-sectional healthcare and treatment of patients with advanced heart failure and multimorbidity lacked coordination, was insufficiently patient-centred and did not cater for close relatives' needs. The study identifies patient-centredness and coordination of healthcare services targeting patients and close relatives alike as critical to proper care, medical curriculum development and continued medical training courses.
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Affiliation(s)
| | - Helén Lönnberg
- Unit for Teaching and Learning, Karolinska Institutet, Sweden
| | | | | | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Denmark
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Rasmussen AA, Fridlund B, Nielsen K, Rasmussen TB, Thrysoee L, Borregaard B, Thorup CB, Berg SK, Mols RE. Gender differences in patient-reported outcomes in patients with acute myocardial infarction. Eur J Cardiovasc Nurs 2022; 21:772-781. [PMID: 35404414 DOI: 10.1093/eurjcn/zvac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 12/29/2022]
Abstract
AIMS Women report worse health-related patient-reported outcomes (PROs) compared with men following acute myocardial infarction (AMI). However, this association is not well established when accounting for demographic and clinical patient characteristics at discharge. This knowledge is essential for clinicians when planning individualised care for patients following AMI. The aim of this study is to examine whether gender is associated with health-related PROs at discharge from a Danish heart centre, combining PROs with data from the national health and administrative registries. METHODS AND RESULTS A cross-sectional study of 2131 patients with AMI discharged from a Danish heart centre responding to the following health-related PRO questionnaires: the Health-survey Short-Form-12 (SF-12), generating a physical component summary (PCS) and a mental component summary (MCS) score; the HeartQoL, providing a global, emotional, and physical score; the EuroQol five-dimensional questionnaire (EQ-5D-5L) and the EQ visual analogue scale (EQ VAS); the Hospital Anxiety and Depression Scale (HADS), generating an anxiety and depression score (HADS-A and HADS-D); the Edmonton Symptom Assessment Scale (ESAS); the Brief Illness Perception Questionnaire (B-IPQ). Patient-reported outcomes were linked to registry-based information adjusting for potential demographic and clinical confounding factors. In adjusted regression models, women reported worse health-related PROs compared with men in SF-12 PCS and SF-12 MCS, HeartQoL global, the HeartQoL emotional and HeartQoL physical score, EQ-5D-5L and EQ VAS, the HADS-A, ESAS, and in six out of eight B-IPQ items. CONCLUSIONS Women reported worse health-related PROs compared with men. Health-related PROs have the potential to be further investigated to facilitate a more individualised healthcare follow-up after AMI.
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Affiliation(s)
- Anne Ankerstjerne Rasmussen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway.,Centre for Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, 351 95 Växjö, Sweden
| | - Karina Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte, Kildegaardsvej 28, 2900 Hellerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, J.B Winsløvs Vej 4, 5000 Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, J.B Winsløvs Vej 19, 3, 5000 Odense C, Denmark
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, J.B Winsløvs Vej 4, 5000 Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, J.B Winsløvs Vej 19, 3, 5000 Odense C, Denmark.,Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology, Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark
| | - Selina Kikkenborg Berg
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.,Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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Rotvig C, Christensen AV, Juel K, Svendsen JH, Jørgensen MB, Rasmussen TB, Borregaard B, Thrysoee L, Thorup CB, Mols RE, Berg SK. The association between cardiac drug therapy and anxiety among cardiac patients: results from the national DenHeart survey. BMC Cardiovasc Disord 2022; 22:280. [PMID: 35725383 PMCID: PMC9210711 DOI: 10.1186/s12872-022-02724-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuropsychiatric side effects of cardiac drugs such as nervousness, mood swings and agitation may be misinterpreted as symptoms of anxiety. Anxiety in cardiac patients is highly prevalent and associated with poor outcomes, thus an accurate identification is essential. The objectives were to: (I) describe the possible neuropsychiatric side effects of common cardiac drug therapies, (II) describe the use of cardiac drug therapy in cardiac patients with self-reported symptoms of anxiety compared to those with no symptoms of anxiety, and (III) investigate the association between the use of cardiac drug therapy and self-reported symptoms of anxiety. METHODS DenHeart is a large national cross-sectional survey combined with national register data. Symptoms of anxiety were measured by the Hospital Anxiety and Depression Scale (HADS-A) on patients with ischemic heart disease, arrhythmia, heart failure and heart valve disease. Side effects were obtained from 'product summaries', and data on redeemed prescriptions obtained from the Danish National Prescription Registry. Multivariate logistic regression analyses explored the association between cardiac drug therapies and symptoms of anxiety (HADS-A ≥ 8). RESULTS Among 8998 respondents 2891 (32%) reported symptoms of anxiety (HADS-A ≥ 8). Neuropsychiatric side effects were reported from digoxin, antiarrhythmics, beta-blockers, ACE-inhibitors and angiotensin receptor antagonists. Statistically significant higher odds of reporting HADS ≥ 8 was found in users of diuretics, lipid-lowering agents, nitrates, antiarrhythmics and beta-blockers compared to patients with no prescription. CONCLUSION Some cardiac drugs were associated with self-reported symptoms of anxiety among patients with cardiac disease. Of these drugs neuropsychiatric side effects were only reported for antiarrhythmics and beta-blockers. Increased awareness about the possible adverse effects from these drugs are important.
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Affiliation(s)
- Camilla Rotvig
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Balslev Jørgensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Psychiatric Centre Copenhagen, and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lars Thrysoee
- 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
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Selina Kikkenborg Berg
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Cromhout PF, Christensen AV, Jørgensen MB, Ekholm O, Juel K, Svendsen JH, Osler M, Rasmussen TB, Borregaard B, Mols RE, Thrysoee L, Thorup CB, Berg SK. Exploring the use of psychotropic medication in cardiac patients with and without anxiety and its association with 1-year mortality. Eur J Cardiovasc Nurs 2021; 21:612-619. [PMID: 35020894 DOI: 10.1093/eurjcn/zvab111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/27/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022]
Abstract
AIMS Comorbid psychiatric disorders and the use of psychotropic medication are common among cardiac patients and have been found to increase the risk of mortality. The aims of this study were: (i) to describe the use of psychotropic medication among cardiac patients with and without symptoms of anxiety, (ii) to estimate the association between use of psychotropic medication prior to hospital admission and all-cause, 1-year mortality following discharge, and (iii) to estimate the risk of mortality among users and non-users of psychotropic medication with or without self-reported symptoms of anxiety. METHODS AND RESULTS Cardiac patients from the DenHeart survey were included, providing information on self-reported symptoms of anxiety. From national registers, information on the use of psychotropic medication 6 months prior to hospitalization and mortality was obtained. By logistic regression analyses, the association between the use of psychotropic medication, anxiety, and all-cause, 1-year mortality was estimated. The risk of subsequent incident use of psychotropic medication among patients with and without anxiety was furthermore explored. All analyses were fully adjusted. A total of 12 913 patients were included, of whom 18% used psychotropic medication, and 3% died within 1 year. The use of psychotropic medication was found to be associated with increased 1-year all-cause mortality [odds ratio 1.90 (95% confidence interval, 1.46-2.46)]. Patients with symptoms of anxiety were significantly more likely to use psychotropic medication following hospital discharge [2.47 (2.25-2.72)]. CONCLUSION The use of psychotropic medication was associated with 1-year mortality. Thus, the use of psychotropic medication might explain some of the association between anxiety and mortality; however, the association is probably mainly a reflection of the underlying mental illness, rather than the use of psychotropic medication.
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Affiliation(s)
- Pernille Fevejle Cromhout
- Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anne Vinggaard Christensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Martin Balslev Jørgensen
- Psychiatric Centre Copenhagen, Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.,Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark.,Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology, Cardiac Surgery & Clinical Nursing Research Unit, Aalborg University Hospital, Hobrovej 18, 9000 Aalborg, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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Thorup CB, Berg SK, Mols RE, Fonager K, Ekholm O, Thrysoee L, Rasmussen TB, Christensen AV, Borregaard B. Are patient-reported outcomes at discharge associated with employment status after cardiac hospitalization? Results from the national DenHeart study. Eur J Cardiovasc Nurs 2021; 21:453-463. [PMID: 34570213 DOI: 10.1093/eurjcn/zvab088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/20/2021] [Accepted: 09/12/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION In patients hospitalized for cardiac disease, a more comprehensive understanding of the potential predictors of returning to the workforce or detachment from employment is lacking. AIM The aims were (i) to explore the patterns of employment status within 1 year following hospital discharge and (ii) to investigate the association between self-reported physical health, mental health, and symptom burden at discharge and employment status at 13, 26, and 52 weeks, respectively, following discharge. METHODS AND RESULTS Patients discharged from Danish heart centres from April 2013 to April 2014 who were a part of the workforce prior to hospitalization and aged 18-63 were included. Questionnaires were used to measure physical and mental health and symptom burden. Information on comorbidity and return to the workforce was obtained from registers. Multiple logistic regression models were used to estimate the associations between self-reported health status and returning to the workforce. Of the 5365 patients, 14.1% had not returned to the workforce 52 weeks after discharge. Patients admitted due to 'observation for a cardiac disease' had the highest proportion (89.4%) and patients with heart failure had the lowest proportion (72.6%) of returning to the workforce. Poor self-reported physical and mental health and high symptom burden were associated with detachment from the workforce. CONCLUSION Self-reported health status measured at discharge may be beneficial for identifying patients at increased risk of detachment from the workforce. Occupational initiatives may be implemented in the initial period after discharge, remembering that not all patients will benefit from returning to the workforce.
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Affiliation(s)
- Charlotte Brun Thorup
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Department of Cardiothoracic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Clinical Nursing Research Unit, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, J. B Winsløvs Vej 4, 5000 Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | | | | | - Britt Borregaard
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark.,Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J. B Winsløvs Vej 4, 5000 Odense C, Denmark
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Tjustrup NC, Engel Schmidt S, Christensen AV, Rasmussen TB, Borregaard B, Thrysoee L, Mols RE, Thorup CB, Juel K, Ankerstjerne A, Berg SK. Patient-reported outcomes, clinical, and demographic variables as predictors of withdrawal from the workforce after hospitalization with heart failure: findings from the national DenHeart survey. Eur J Cardiovasc Nurs 2021; 21:332-340. [PMID: 34499708 DOI: 10.1093/eurjcn/zvab073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/11/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022]
Abstract
AIMS Increased prevalence and survival among patients with heart failure draws attention to their everyday life, including their ability to work. Many patients with heart failure withdraw from the workforce, which can affect their quality of life. The aim was to investigate patient-reported outcomes (PROs) and clinical and demographic variables as predictors of withdrawal from the workforce after admission with a diagnose of heart failure. METHODS AND RESULTS Patients with heart failure, who were part of the workforce at admission were included from the national cross-sectional survey, DenHeart. Data were collected from five national heart centres in Denmark, from April 2013 to April 2014. Patient-reported outcomes measured at discharge included SF-12, HeartQoL, HADS, and ESAS. Clinical and demographic variables were obtained from registers, medical records, and index hospitalization. Patient-reported outcomes, clinical, and demographic variables were combined with labour market affiliation 3, 6, 9, and 12 months after admission. The response rate was 49.1% (n = 1517) and of those 364 patients were part of the workforce at index admission. Patients with lower QoL odds ratio (OR) 2.58 [95% confidence interval (CI) 1.24-5.37], symptoms of depression OR 2.57 (95% CI 1.47-4.50) and ejection fraction (EF) ≤35% OR 2.48 (95% CI 1.35-4.56) were more likely to withdraw from the workforce in the first year after admission. Patients with lower symptom burden OR 0.36 (95% CI 0.19-0.68) and a hospital stay of 0-2 days OR 0.18(95% CI 0.08-0.37) were less likely to withdraw. CONCLUSION Low QoL, high symptom burden, symptoms of depression, a longer length of hospital stay, and low EF can predict withdrawal from the workforce in the first year after admission with heart failure.
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Affiliation(s)
- Nina Cecilie Tjustrup
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N 2200, Denmark
| | - Signe Engel Schmidt
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N 2200, Denmark
| | - Anne Vingaard Christensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Trine Bernholdt Rasmussen
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N 2200, Denmark.,Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Clinical Nursing Research Unit, Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen 1455, Denmark
| | - Anne Ankerstjerne
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Selina Kikkenborg Berg
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N 2200, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark.,National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen 1455, Denmark
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10
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Blakoe M, Christensen AV, Palm P, Højskov IE, Thrysoee L, Thorup CB, Borregaard B, Mols RE, Rasmussen TB, Berg SK. Prognostic value of a brief loneliness questionnaire for patients with coronary heart disease: Proposal for a prediction model. J Clin Nurs 2021; 31:1686-1696. [PMID: 34473870 DOI: 10.1111/jocn.16023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/15/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients with coronary heart disease (CHD), loneliness is associated with increased risk of morbidity and mortality. No predictive tool is available to detect patients who are influenced by loneliness to a degree that impacts mortality. AIM To: (i) propose a prediction model that detects patients influenced by loneliness to a degree that increases one-year all-cause mortality, (ii) evaluate model classification performance of the prediction model, and (iii) investigate potential questionnaire response errors. METHOD A cohort of patients with CHD (n = 7169) responded to a national cross-sectional survey, including two questions on loneliness. Information on cohabitation and follow-up information on one-year all-cause mortality were obtained from national registers. Prediction model development was based on the prognostic values of item responses in the questionnaire on loneliness and of cohabitation, evaluated with Cox-proportional Hazards Ratio (HR). Item responses which significantly predicted one-year mortality were included in the high-risk loneliness (HiRL) prediction model. Sensitivity, specificity and likelihood ratio were calculated to evaluate model classification performance. Sources of response errors were evaluated using verbal probing technique in an additional cohort (n = 7). The TRIPOD checklist has been used to ensure transparent reporting. RESULTS Two item responses significantly predicted one-year mortality HR = 2.24 (95%CI = 1.24-4.03) and HR = 2.65 (95%CI = 1.32-5.32) and were thus included in the model. Model classification performance showed a likelihood ratio of 1.89. Response error was evaluated as low. CONCLUSION Based on the prognostic value in a loneliness questionnaire, a prediction model suitable to screen patients with CHD for high-risk loneliness was suggested. RELEVANCE TO CLINICAL PRACTICE The HiRL prediction model is a short and easy-to-use screening tool that offers clinical staff to identify patients with CHD who are influenced by loneliness to a degree that impacts mortality. However, further evaluation of model performance and questionnaire validation is recommended before integrating the model into clinical practice.
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Affiliation(s)
- Mitti Blakoe
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Pernille Palm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ida Elisabeth Højskov
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology and Department of Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Britt Borregaard
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Selina Kikkenborg Berg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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11
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Rotvig C, Christensen AV, Rasmussen TB, Borregaard B, Thrysoee L, Juel K, Thorup CB, Mols RE, Berg SK. Unreadiness for hospital discharge predicts readmission among cardiac patients: results from the national DenHeart survey. Eur J Cardiovasc Nurs 2021; 20:667-675. [PMID: 33713110 DOI: 10.1093/eurjcn/zvab017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/18/2020] [Accepted: 02/17/2021] [Indexed: 11/13/2022]
Abstract
AIMS Readiness for hospital discharge describes a patient's perception of feeling prepared to leave the hospital. In mixed patient populations, readiness for hospital discharge has shown to predict readmission and mortality in the short term. The objectives of a population of men and women with cardiac diseases, were to investigate: (i) whether readiness for hospital discharge predicts readmission and mortality within 1-year post-discharge, as well as (ii) the association between 'physical stability', 'adequate support', 'psychological ability', and 'adequate information and knowledge' and readiness for hospital discharge. METHODS AND RESULTS Data from the national cross-sectional survey DenHeart were used and included patients with cardiac diseases at hospital discharge. Readiness for hospital discharge was evaluated by one self-reported question, and attributes were illuminated by Short-Form-12, the Edmonton Symptom Assessment Scale and ancillary questions. Data were combined with national registries at baseline and at 1-year follow-up. Cox proportional-hazards model were used to regress readmission and mortality. The analysis included 13 114 patients (response rate: 52%). The majority responded that they felt ready for hospital discharge (95%). Feeling unready (n = 618) was a predictor of 1 year, all-cause readmission among women and men [hazard ratio (HR) = 1.43, 95% confidence interval (CI) 1.18-1.74; HR = 1.59, 95% CI 1.34-1.90]. No significant results were found on all-cause mortality. The four attributes were associated with unreadiness at hospital discharge. CONCLUSION Not feeling ready for hospital discharge was a predictor of increased readmission risk in women and men with cardiac disease during 1 year after hospital discharge. Four attributes were significantly impaired in patients feeling unready for hospital discharge.
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Affiliation(s)
- Camilla Rotvig
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anne Vinggaard Christensen
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte hospitalsvej 1, 2900 Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark.,Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology, Aalborg University Hospital, Reberbansgade 9000 Aalborg, Denmark.,Department of Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Reberbansgade 9000 Aalborg, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Selina Kikkenborg Berg
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
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12
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Mols RE, Hald M, Vistisen HS, Lomborg K, Maeng M. Nurse-led Motivational Telephone Follow-up After Same-day Percutaneous Coronary Intervention Reduces Readmission and Contacts to General Practice. J Cardiovasc Nurs 2020; 34:222-230. [PMID: 30789491 DOI: 10.1097/jcn.0000000000000566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Same-day discharge of patients undergoing percutaneous coronary intervention (PCI) may challenge preparation of patients for discharge. OBJECTIVE The objective of this study was to investigate whether nurse-led telephone follow-up influenced patients' self-management post-PCI. METHODS We performed a randomized study with an allocation rate of 1:1. A standardized nurse-led motivational telephone consultation was conducted between 2 and 5 days after PCI to support adherence to medical therapy, follow-up activities, emotional well-being, and healthy lifestyle. The control group received usual care and discharge procedures. Primary outcome was adherence to use of P2Y12 inhibitor (clopidogrel or ticagrelor) therapy at 30 days of follow-up. RESULTS We consecutively included 294 elective patients (83%) undergoing PCI and with planned same-day discharge. Adherence to P2Y12 inhibitors was not influenced by the intervention (intervention vs control, 95% vs 93%, respectively; P = .627). However, the proportion of patients readmitted (8% vs 16%, P = .048), as well as self-initiated contacts to general practitioners (29% vs 42%, P = .020), was lower in the intervention group compared with the control group. Patients in the intervention group were more likely to know how to manage symptoms of angina pectoris (90% vs 80%, P = .015), and a higher proportion of patients in the intervention group commenced healthy physical activities (53% vs 41%, P = .043). CONCLUSION Nurse-led motivational telephone follow-up did not influence adherence to antiplatelet medical therapy after PCI. However, the intervention positively influenced self-management of angina pectoris and reduced hospital readmissions and self-initiated contacts to general practitioners and hospitals.
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Affiliation(s)
- Rikke Elmose Mols
- Rikke Elmose Mols, PhD, RN Healthcare Researcher, Department of Cardiology, Aarhus University Hospital, Denmark. Marianne Hald, RNProject Nurse, Department of Cardiology, Aarhus University Hospital, Denmark. Heidi Soenderby Vistisen, MCn, RNDevelopment Nurse, Department of Cardiology, Aarhus University Hospital, Denmark. Kirsten Lomborg, PhD, RNProfessor, Department of Clinical Medicine, Aarhus University; and the Research Program in Patient Involvement, Aarhus University Hospital, Denmark. Michael Maeng, PhD, MD Associated Professor and Invasive Cardiologist, Department of Cardiology, Aarhus University Hospital, Denmark
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13
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Rasmussen AA, Wiggers H, Jensen M, Berg SK, Rasmussen TB, Borregaard B, Thrysoee L, Thorup CB, Mols RE, Larsen SH, Johnsen SP. Patient-reported outcomes and medication adherence in patients with heart failure. Eur Heart J Cardiovasc Pharmacother 2020; 7:287-295. [PMID: 32761093 DOI: 10.1093/ehjcvp/pvaa097] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/31/2020] [Accepted: 07/31/2020] [Indexed: 11/14/2022]
Abstract
AIMS Patient-reported outcome measures (PROMs) may predict poor clinical outcome in patients with heart failure (HF). It remains unclear whether PROMs are associated with subsequent adherence to HF medication. We aimed to determine whether health-related quality of life, anxiety, and depression were associated with long-term medication adherence in these patients. METHODS AND RESULTS A national cohort study of Danish patients with HF with 3-year follow-up (n = 1464). PROMs included the EuroQol five-dimensional, five-level questionnaire (EQ-5D-5L), the HeartQoL and the Hospital Anxiety and Depression Scale (HADS). Patient-reported outcomes (PRO) data were linked to demographic and clinical data at baseline, and data on all redeemed prescriptions for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor neprilysin inhibitors (ACEI/ARB/ARNI), β-blockers, and mineralocorticoid receptor antagonists during follow-up. Medication non-adherence was defined as <80% of proportion of days covered. In adjusted regression analyses, lower health-related quality of life (EQ-5D and HeartQoL) and symptoms of depression (HADS-D) at discharge were associated with non-adherence. After 3 years of follow-up, lower health-related quality of life (EQ-5D) was associated with non-adherence for ACEI/ARB/ARNI [adjusted OR 2.78, 95% confidence interval (CI): 1.19-6.49], β-blockers (adjusted OR 2.35, 95% CI: 1.04-5.29), whereas HADS-D was associated with non-adherence for ACEI/ARB/ARNI (adjusted OR 1.07, 95% CI: 1.03-1.11) and β-blockers (adjusted OR 1.06, 95% CI: 1.02-1.10). CONCLUSION Lower health-related quality of life and symptoms of depression were associated with non-adherence across HF medications at 1 and 3 years of follow-up. Person-centred care using PROMs may carry a potential for identifying patients at increased risk of future medication non-adherence.
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Affiliation(s)
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Martin Jensen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Selina Kikkenborg Berg
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | | | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense C, Denmark.,Department of Cardiology, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology, Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Signe Holm Larsen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
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14
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Rasmussen AA, Larsen SH, Jensen M, Berg SK, Rasmussen TB, Borregaard B, Thrysoee L, Thorup CB, Mols RE, Wiggers H, Johnsen SP. Prognostic impact of self-reported health on clinical outcomes in patients with heart failure. Eur Heart J Qual Care Clin Outcomes 2020; 7:397-406. [PMID: 32232437 DOI: 10.1093/ehjqcco/qcaa026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 12/28/2022]
Abstract
AIMS An in-depth understanding of the prognostic value of patient-reported outcomes (PRO) is essential to facilitate person-centred care in heart failure (HF). This study aimed to clarify the prognostic role of subjective mental and physical health status in patients with HF. METHODS AND RESULTS Patients with HF were identified from the DenHeart Survey (n = 1499) and PRO data were obtained at hospital discharge, including the EuroQol five-dimensional questionnaire (EQ-5D), the HeartQoL, and the Hospital Anxiety and Depression Scale (HADS). Clinical baseline data were obtained from medical records and linked to nationwide registries with patient-level data on sociodemographics and healthcare contacts. Outcomes were all-cause and cardiovascular (CV) mortality, CV events, and HF hospitalization with 1- and 3-year follow-up. Analysing the PRO data on a continuous scale, a worse score in the following were associated with risk of all-cause and CV mortality after 1 year: the HeartQoL (adjusted hazard ratios (HRs) 1.91, 95% confidence interval (CI) 1.42-2.57 and 2.17, 95% CI 1.50-3.15, respectively), the EQ-5D (adjusted HRs 1.26, 95% CI 1.15-1.38 and 1.27, 95% CI 1.13-1.42, respectively), the HADS depression subscale (adjusted HRs 1.12, 95% CI 1.07-1.17 and 1.11, 95% CI 1.05-1.17, respectively), and the HADS anxiety subscale (adjusted HRs 1.08, 95% CI 1.03-1.13 and 1.09, 95% CI 1.04-1.15, respectively). Three-year results were overall in concordance with the 1-year results. A similar pattern was also observed for non-fatal outcomes. CONCLUSION Health-related quality of life and symptoms of anxiety and depression at discharge were associated with all-cause and CV mortality at 1- and 3-year follow-up.
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Affiliation(s)
- Anne Ankerstjerne Rasmussen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Signe Holm Larsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Martin Jensen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark
| | - Selina Kikkenborg Berg
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Kildegaardsvej 28, 2900 Hellerup, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J.B Winsløvs Vej 4, 5000 Odense C, Denmark.,Department of Cardiology, Odense University Hospital, J.B Winsløvs Vej 4, 5000 Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, J.B Winsløvs Vej 19,3, 5000 Odense C, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, J.B Winsløvs Vej 4, 5000 Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, J.B Winsløvs Vej 19,3, 5000 Odense C, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology, Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark
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15
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Christensen AV, Dixon JK, Juel K, Ekholm O, Rasmussen TB, Borregaard B, Mols RE, Thrysøe L, Thorup CB, Berg SK. Psychometric properties of the Danish Hospital Anxiety and Depression Scale in patients with cardiac disease: results from the DenHeart survey. Health Qual Life Outcomes 2020; 18:9. [PMID: 31910859 PMCID: PMC6947856 DOI: 10.1186/s12955-019-1264-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/19/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Anxiety and depression symptoms are common among cardiac patients. The Hospital Anxiety and Depression Scale (HADS) is frequently used to measure symptoms of anxiety and depression; however, no study on the validity and reliability of the scale in Danish cardiac patients has been done. The aim, therefore, was to evaluate the psychometric properties of HADS in a large sample of Danish patients with the four most common cardiac diagnoses: ischemic heart disease, arrhythmias, heart failure and heart valve disease. METHODS The DenHeart study was designed as a national cross-sectional survey including the HADS, SF-12 and HeartQoL and combined with data from national registers. Psychometric evaluation included analyses of floor and ceiling effects, structural validity using both exploratory and confirmatory factor analysis and hypotheses testing of convergent and divergent validity by relating the HADS scores to the SF-12 and HeartQoL. Internal consistency reliability was evaluated by Cronbach's alpha, and differential item functioning by gender was examined using ordinal logistic regression. RESULTS A total of 12,806 patients (response rate 51%) answered the HADS. Exploratory factor analysis supported the original two-factor structure of the HADS, while confirmatory factor analysis supported a three-factor structure consisting of the original depression subscale and two anxiety subscales as suggested in a previous study. There were floor effects on all items and ceiling effect on item 8. The hypotheses regarding convergent validity were confirmed but those regarding divergent validity for HADS-D were not. Internal consistency was good with a Cronbach's alpha of 0.87 for HADS-A and 0.82 for HADS-D. There were no indications of noticeable differential item functioning by gender for any items. CONCLUSIONS The present study supported the evidence of convergent validity and high internal consistency for both HADS outcomes in a large sample of Danish patients with cardiac disease. There are, however, conflicting results regarding the factor structure of the scale consistent with previous research. TRIAL REGISTRATION ClinicalTrials.gov: NCT01926145.
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Affiliation(s)
- Anne Vinggaard Christensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Jane K Dixon
- Yale School of Nursing, Yale University, 400 West Campus Drive, Orange, CT, 06477, USA
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Kildegaardsvej 28, 2900, Hellerup, Denmark
| | - Britt Borregaard
- Cardiothoracic- and Vascular Department, Odense University Hospital, J.B.- Winslows Vej 4, 5000, Odense, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blv. 99, 8200, Aarhus, Denmark
| | - Lars Thrysøe
- Department of Cardiology, Odense University Hospital, University of Southern Denmark, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology and Cardiothoracic Surgery, Clinical Nursing Research Unit, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, København N, Denmark
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16
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Christensen AV, Bjorner JB, Ekholm O, Juel K, Thrysoee L, Borregaard B, Rasmussen TB, Mols RE, Thorup CB, Berg SK. Increased risk of mortality and readmission associated with lower SF-12 scores in cardiac patients: Results from the national DenHeart study. Eur J Cardiovasc Nurs 2019; 19:330-338. [PMID: 31696734 DOI: 10.1177/1474515119885480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The SF-12v2 health survey (SF-12) is widely used as a generic measure of health-related quality of life. However, interpretation of score differences can be difficult. AIM To estimate benchmarks for interpretation of score differences on the SF-12 for readmission and all-cause mortality in cardiac patients. METHODS Data from the DenHeart study, a national cross-sectional survey including one year follow-up register data, were used. Patients with ischaemic heart disease, arrhythmia, heart failure and heart valve disease answered the survey at hospital discharge. Cox proportional hazards models were used to regress readmission and all-cause mortality. RESULTS A total of 10,813 cardiac patients completed the SF-12. For patients with ischaemic heart disease and arrhythmia, a one point lower physical component summary score was associated with a 2% increase in risk in readmission (hazard ratio (HR) 1.022 (95% confidence interval 1.017;1.027) and HR 1.024 (1.018; 1.029), respectively) and a 3% increase in risk for patients with heart failure (HR 1.027 (1.015; 1.038)). A one point lower mental component summary score was associated with a 2% increase in the risk of readmission (HR 1.017 (1.013; 1.022)) across diagnoses. For both the physical and mental component summary score, a one point lower score meant a 5% increase in the risk of all-cause mortality (HR 1.046 (1.031; 1.060) and HR 1.046 (1.029; 1.065), respectively) across diagnoses. CONCLUSION In a large group of cardiac patients, a one point lower physical or mental component summary score was associated with an up to 3% increased risk of readmission and a 5% increased risk of mortality in the first year after discharge.
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Affiliation(s)
| | - Jakob Bue Bjorner
- Optum Patient Insights, USA.,Section of Social Medicine, University of Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Denmark
| | - Britt Borregaard
- Cardiothoracic and Vascular Department, Odense University Hospital, Denmark
| | | | | | - Charlotte Brun Thorup
- Department of Cardiology, Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.,National Institute of Public Health, University of Southern Denmark, Denmark
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Mols RE, Nørgaard BL, Vedsted P, Farkas DK, Bøtker HE, Jensen JM. General practice preventive health care in non-obstructive coronary artery disease determined by coronary computed tomography angiography. Int J Cardiol 2019; 278:14-21. [DOI: 10.1016/j.ijcard.2018.09.094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 08/19/2018] [Accepted: 09/24/2018] [Indexed: 01/24/2023]
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19
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Berg SK, Rasmussen TB, Thrysoee L, Thorup CB, Borregaard B, Christensen AV, Mols RE, Juel K, Ekholm O. Mental health is a risk factor for poor outcomes in cardiac patients: Findings from the national DenHeart survey. J Psychosom Res 2018; 112:66-72. [PMID: 30097138 DOI: 10.1016/j.jpsychores.2018.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To explore (i) the prevalence of cardiac risk factors (obesity, smoking, excessive alcohol consumption and medication non-adherence) among cardiac patients with depression and anxiety, (ii) associations between depression and anxiety scores and cardiac risk factors and (iii) the association of depression and anxiety and cardiac risk factors with mortality, and their population attributable risk. METHODS A national cross-sectional study using patient-reported outcomes at discharge and national register data. For one year (April 15th 2013 to April 15th 2014) all patients discharged or transferred from the five Danish Heart Centres were included in the study. A total of 14,239 patients answered the HADS questionnaire, response rate 51%. RESULTS Mean age was 64.8 years and 69% were male. Patients with depression or anxiety (HADS-D or HADS-A score ≥ 8) had 30% and 45%, respectively, higher odds of being current smokers; 19% and 37% higher odds of being obese and 31% and 24% higher odds of excessive alcohol consumption. Depressive patients had 34% higher odds of being non-adherent to their medication. At one-year follow-up, patients with depression (HADS-D score ≥ 11) had the highest attributable risk associated with mortality followed by: smoking, ischemic heart disease, anxiety, diabetes, hypertension chronic obstructive pulmonary disease and excessive alcohol consumption. CONCLUSION Depression and anxiety in patients with cardiac disease is associated with cardiac risk behaviour such as smoking, obesity, excessive alcohol consumption and medication non-adherence. Depression and anxiety have an attributable risk associated with mortality that is comparable to other well-known risk factors such as smoking.
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Affiliation(s)
- Selina Kikkenborg Berg
- Department of Cardiology, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Trine Bernholdt Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, University of Southern Denmark, J.B. Winsløwsvej 4, 5000 Odense C, Denmark.
| | - Charlotte Brun Thorup
- Department of Cardiology, Department of Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløwsvej 4, 5000 Odense C, Denmark.
| | | | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blv. 99, 8200 Aarhus N, Denmark.
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 1353 Copenhagen, Denmark.
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 1353 Copenhagen, Denmark.
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Berg SK, Rasmussen TB, Mols RE, Thorup CB, Borregaard B, Christensen AV, Cromhout PF, Ekholm O, Juel K, Thrysoee L. Both mental and physical health predicts one year mortality and readmissions in patients with implantable cardioverter defibrillators: findings from the national DenHeart study. Eur J Cardiovasc Nurs 2018; 18:96-105. [DOI: 10.1177/1474515118794598] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | - Charlotte Brun Thorup
- Department of Cardiology and Department of Cardiothoracic Surgery, Aalborg University Hospital, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark
| | | | | | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Denmark
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21
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Devantier TA, Nørgaard BL, Sand NP, Mols RE, Foldager L, Diederichsen AC, Thomsen KK, Jensen JM, Videbech P. Lack of Correlation Between Depression and Coronary Artery Calcification in a Non-Selected Danish Population. Psychosomatics 2013; 54:458-65. [DOI: 10.1016/j.psym.2013.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 01/09/2013] [Accepted: 01/10/2013] [Indexed: 11/29/2022]
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22
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Mols RE, Sand NP, Jensen JM, Thomsen K, Diederichsen ACP, Nørgaard BL. Social factors and coping status in asymptomatic middle-aged Danes: Association to coronary artery calcification. Scand J Public Health 2013; 41:737-43. [DOI: 10.1177/1403494813492032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Aims: Understanding the determinants of social and coping inequalities in subclinical cardiovascular disease is an important prerequisite in developing and implementing preventive strategies. The aim of this study was to investigate the association between social factors and coping status, respectively, and subclinical coronary artery disease (CAD) in middle-aged Danes. Methods: This is a DanRisk screening substudy, thus including healthy Danish males and females aged 50 or 60 years. Social measures included grade of education, employment and co-habiting status. The coping status was estimated by the general self-efficacy (GES) scale. Coronary artery calcification (CAC) was assessed by computed tomography using the Agatston score (AS). Conventional clinical risk factors included sex, family history of CAD, BMI > 25, smoking, hypercholesterolaemia and hypertension. Results: In 568 individuals the prevalence of subjects with CAC was 267 (45%). Independent predictors of CAC in males were age (OR = 1.10, 95% CI = 1.04–1.16, p < 0.001), smoking (OR = 1.75, 95% CI = 1.03–2.99, p = 0.038), and low co-habiting status (OR = 3.66, 95% CI = 1.19–11.25, p = 0.023). Independent predictors in females were age (OR = 1.67, 95% CI = 1.02–1.12, p = 0.006), and smoking (OR = 1.71, 95% CI = 1.06–2.78, p = 0.029). Higher AS was associated to lower employment level in females ( p = 0.001) but not in males ( p = 0.833). Conclusions: Social factors are associated to the prevalence and severity of CAC in asymptomatic middle-aged individuals with gender differences. The relative value of gender specific social versus conventional clinical risk factors in the risk assessment of subclinical CAC in middle-aged individuals needs further investigation in future prospective studies.
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Affiliation(s)
| | | | | | | | | | - Bjarne Linde Nørgaard
- Department of Cardiology, Lillebaelt Hospital-Vejle, Denmark
- Department of Cardiology, Aarhus University Hospital-Skejby, Denmark
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