Psychosocial Factors and Rehospitalization after Acute Myocardial Infarction

描述(由申请人提供)：每年有100多万美国人因急性心肌梗死(AMI)住院。虽然高达90%的人在指数住院期间存活下来，但早期再住院是很常见的。近五分之一的医疗保险患者在急性心肌梗死后30天内再次入院。确定哪些患者是早期再入院的风险最高的患者，以及哪些患者可以从出院计划计划中获得最大利益，这对临床和公共卫生具有相当重要的意义。虽然有几项研究已经确定了与再次住院有关的人口统计学和临床特征，但很少有研究研究心理社会因素对患者坚持有效的药物治疗方案并做出推荐的行为改变(包括改变他们的饮食和活动水平)的能力所起的作用。认知障碍(CI)和抑郁等因素可能会影响心血管疾病的预后。关于因急性心肌梗死住院的患者的有限数据表明，超过一半的患者存在认知障碍，其中三分之二的患者CI未被识别。在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。与非认知功能受损或抑郁的患者相比，入院时患有CI或抑郁症的患者在活动能力和日常生活能力方面的改善较少，更有可能再次住院，死亡率更高。在2011年Worcester心脏病研究(WHAS)队列研究的背景下，我们将通过电话访谈测量出院后1周和6周的几个心理社会因素，包括CI和抑郁以及AMI自我管理行为，以实现三个具体目标：1)描述出院后1周和6周AMI幸存者的CI和抑郁的患病率和变化；2)检测急性心肌梗死患者出院后6周的自我管理行为随CI和出院后1周抑郁的变化程度，以及出院后1~6周这些因素的变化；3)检查出院后1周和6周的CI和抑郁对再住院率和死亡率的影响。这项研究将把重要的心理社会因素、CI和抑郁症的测量添加到作为WHAS的一部分而收集的丰富的临床和治疗数据库中，包括再次住院和全原因死亡的随访。这些结果将为根据患者的心理社会状况制定出院计划计划和教育干预措施奠定基础，并可作为其他慢性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.