Psychosocial Factors and Rehospitalization after Acute Myocardial Infarction

描述（由申请人提供）：每年有超过100万美国人因急性心肌梗死（AMI）住院。虽然高达90%的患者在首次住院后存活，但早期再次住院是常见的。近五分之一的医保患者在急性心肌梗死后30天内再次入院。确定早期再入院风险最高的患者，以及可能从出院计划方案中最大程度受益的患者，具有相当大的临床和公共卫生重要性。虽然有几项研究已经确定了与再入院相关的人口学和临床特征，但很少有研究调查了影响患者坚持有效药物治疗方案和做出建议的行为改变（包括改变饮食和活动水平）的能力的心理社会因素的作用。认知障碍（CI）和抑郁等因素可能影响心血管疾病的预后。AMI住院患者CI的有限数据表明，超过一半的患者认知受损，其中三分之二的患者CI未被识别。因急性心肌梗死住院的患者中有三分之一到一半患有抑郁症。入院时患有CI或抑郁症的患者在行动能力和日常生活活动方面改善较少，更有可能再次住院，并且比没有认知障碍或抑郁症的患者死亡率更高。伍斯特在2011年的背景下的心脏病研究(成果),以人群为基础的监测研究,为AMI患者住院,我们将测量通过电话采访几个心理因素包括CI和抑郁和AMI自我管理行为1和6周后出院为了完成三个具体目标:1)描述的患病率,并改变,CI和抑郁之间的幸存者AMI 1和6周后出院;2)探讨AMI患者出院后6周自我管理行为随出院后1周CI和抑郁程度的变化程度，以及出院后1 ~ 6周这些因素的变化情况；3)检查出院后1周和6周时CI和抑郁程度不同，30天和1年再住院率和死亡率是否不同。这项研究将增加重要的社会心理因素、CI和抑郁的测量，以收集丰富的临床和治疗数据库，作为WHAS的一部分，包括再住院和全因死亡率的随访。这些结果将为制定适合患者心理社会状况的出院计划方案和教育干预措施奠定基础，并可作为其他慢性疾病急性加重患者的模型。

DESCRIPTION (provided by applicant): More than one million Americans are hospitalized each year for acute myocardial infarction (AMI). While up to 90% survive their index hospitalization, early rehospitalization is common. Nearly one fifth of Medicare patients are readmitted within 30 days of an AMI. Identifying patients who are at the highest risk for early readmission, and who may maximally benefit from discharge planning programs, is of considerable clinical and public health importance. While several studies have identified demographic and clinical characteristics associated with hospital readmission, few studies have examined the role of psychosocial factors that impact a patient's ability to adhere to effective medication regimens and make recommended behavioral changes, including alterations in their diet and activity level. Factors such as cognitive impairment (CI) and depression may affect CVD outcomes. Limited data on CI in patients hospitalized for AMI suggest that more than one half are cognitively impaired and that in two-thirds of these patients CI is unrecognized. Between one-third to one-half of patients hospitalized for AMI are depressed. Patients with CI or depression at the time of hospital admission improve less in mobility and activities of daily living, are more likely to be rehospitalized, and experience higher death rates than patients who are not cognitively impaired or depressed. In the context of the 2011 cohort of the Worcester Heart Attack Study (WHAS), a population-based surveillance study of patients hospitalized for AMI, we will measure via a phone interview several psychosocial factors including CI and depression and AMI self-management behaviors at 1 and 6 weeks after hospital discharge in order to accomplish three specific aims: 1) To describe the prevalence of, and change in, CI and depression among survivors of AMI at 1 and 6 weeks after hospital discharge; 2) To examine the extent to which AMI self-management behaviors at 6 weeks post-discharge vary according to CI and depression at 1-week post discharge and the change in these factors from 1 to 6 weeks post hospital discharge; and 3) To examine whether rates of 30-day and 1-year rehospitalization and mortality vary according to CI and depression at 1 and 6 weeks post hospital-discharge. This study will add measurements of important psychosocial factors, CI and depression, to the rich clinical and treatment database being collected as part of the WHAS, including follow-up for rehospitalization and all-cause mortality. These results will lay the groundwork for the development of discharge planning programs and education interventions tailored to the psychosocial status of patients and could be used as a model for patients with acute exacerbations of other chronic diseases. PUBLIC HEALTH RELEVANCE: More than one million Americans are hospitalized each year for acute myocardial infarction and early rehospitalization is common. Identifying patients who are at the highest risk for early readmission, and who may maximally benefit from discharge planning programs, is of considerable clinical and public health importance. Psychosocial factors, such as cognitive impairment and depression, that impact a patient's ability to adhere to effective medication regimens and make recommended behavioral changes may affect CVD outcomes but have not been systematically examined within the context of a population-based study.