Psychological stress and 30-day all-cause hospital readmission in acute coronary syndrome patients: an observational cohort study.
Psychological stress and 30-day all-cause hospital readmission in acute coronary syndrome patients: an observational cohort study.
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DOI：
10.1371/journal.pone.0091477
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Davidson KW
中科院分区：
文献类型：
--
作者：
Edmondson D;Green P;Ye S;Halazun HJ;Davidson KW
许多急性冠状动脉综合征（ACS；心肌梗死和不稳定心绞痛）患者在出院后 30 天内再次住院，美国最近的卫生政策举措已将医院医疗保险报销与 30 天再入院率挂钩。患者感受到的心理压力被认为会影响 ACS 后的预后。最近提供的 30 天再入院“院后综合症”模型认为，指数住院时的压力水平本身可能会增加 ACS 患者 30 天再入院的风险。我们测试了 ACS 住院期间自我报告的压力是否与 30 天内再次入院风险增加相关。出院后平均 8.5 天，342 名连续住院的 ACS 患者报告了他们在过去两周内感到压力的频率。出院后 30 天内因任何原因再次入院的情况是通过对患者进行后续电话询问并通过医院记录确认的。总体而言，40 名（11.7%）参与者在 30 天内重新入院，22 名（6.4%）参与者报告压力较高。高压力患者（5 例入院，23%）30 天内再次入院的情况比低压力患者（35 例入院，11%）更常见。调整人口和临床因素以及抑郁症后，高压力与 30 天再入院风险增加 3 倍相关（HR = 3.21，95% CI= 1.13，9.10）。先前的研究表明，住院期间的压力可能标志着长期心血管风险，但这是第一项检验早期再入院的院后综合症模型假设的研究。需要进一步的研究来确认压力和再入院风险之间的关联，并确定可以修改的住院流程，以减少所经历的压力，并且也可以有效地减少再入院。
Many acute coronary syndrome (ACS; myocardial infarction and unstable angina) patients are rehospitalized within 30 days of discharge, and recent US health policy initiatives have tied hospital Medicare reimbursement to 30-day readmission rates. Patient-perceived psychological stress is thought to impact prognosis after ACS. A recently offered “posthospital syndrome” model of 30-day readmissions posits that the stress level at the time of the index hospitalization itself may increase 30-day risk for readmission in ACS patients. We tested whether self-reported stress in the days surrounding the ACS hospitalization was associated with increased risk for readmission within 30 days. A mean of 8.5 days after discharge, 342 consecutively hospitalized ACS patients reported on how often they felt stress during the past two weeks. Readmission within 30 days of hospital discharge for any cause was determined by follow-up telephone calls to patients and confirmed by hospital records. Overall, 40 (11.7%) participants were readmitted within 30 days, and 22 (6.4%) reported high stress. Readmission within 30 days was more common in patients with high stress (5 admissions, 23%) than in patients with low stress (35 admissions, 11%). After adjustment for demographic and clinical factors, as well as depression, high stress was associated with a 3-fold increased risk of 30-day readmission (HR = 3.21, 95% CI = 1.13, 9.10). Previous research has shown that stress in the days surrounding a hospitalization can mark long-term cardiovascular risk, but this is the first study to test a hypothesis of the posthospital syndrome model of early readmission. Further research is needed to confirm the association between stress and readmission risk, and to identify the processes of hospitalization that could be modified to both reduce the stress experienced and that would also be effective for reducing readmissions.
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