Psychosocial Factors and Rehospitalization after Acute Myocardial Infarction

描述（由申请人提供）：每年有超过一百万的美国人因急性心肌梗死（AMI）住院。虽然高达90%的患者在指数住院后存活，但早期再住院很常见。近五分之一的医疗保险患者在AMI后30天内再次入院。识别早期再入院风险最高的患者，以及可能从出院计划中获益最大的患者，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统计学和临床特征，但很少有研究研究探讨了影响患者坚持有效药物治疗方案并进行推荐行为改变（包括饮食和活动水平的改变）的心理社会因素的作用。认知障碍（CI）和抑郁症等因素可能会影响CVD结局。有限的数据表明，在AMI住院患者的CI超过一半的认知功能受损，并在这些患者的三分之二CI是无法识别的。三分之一到一半的AMI住院患者患有抑郁症。入院时患有CI或抑郁症的患者在活动性和日常生活活动方面的改善较少，更有可能再次住院，并且比没有认知障碍或抑郁症的患者的死亡率更高。在2011年伍斯特心脏病发作研究（WHAS）队列的背景下，一项基于人群的AMI住院患者监测研究，我们将通过电话访谈测量出院后1周和6周的几种心理社会因素，包括CI和抑郁以及AMI自我管理行为，以实现三个特定目标：1）描述AMI幸存者出院后1周和6周CI和抑郁的患病率及其变化; 2）研究AMI患者出院后6周的自我管理行为在多大程度上根据CI和1-出院后1周和出院后6周这些因素的变化;和3）检查30天和1年再住院率和死亡率是否根据出院后1周和6周的CI和抑郁而变化。这项研究将增加重要的心理社会因素，CI和抑郁症的测量，作为WHAS的一部分收集的丰富的临床和治疗数据库，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和教育干预措施奠定基础，并可用作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.