Psychosocial Syndemics and Multimorbidity in Hospitalized Patients with Heart Failure

大约有620万美国人患有心力衰竭（HF），并且患病率正在迅速增加。心力衰竭是一种 老年人住院和死亡的常见原因，HF的住院护理费用是 飙升。HF如此沉重和昂贵的一个原因是它经常并发心血管疾病。 和非心血管合并症，尤其是老年患者。精神和医学疾病， HF发生后，HF事件的风险因素持续存在， 随着HF年龄的增长。因此，HF嵌入在更大的多变体模式中。不幸的是，大多数试验 HF治疗以及许多其他HF研究都排除了患有复杂精神病和 合并症或严重认知障碍。这使得对老年人护理的研究存在很大空白， 成人HF此外，关于社会经济风险因素和健康差距的研究尚未得到充分的重视。 与HF中的多morphine研究相结合。心力衰竭只是患者面临的多重挑战之一 有多重人格，紧张的社会经济环境和心理社会问题，但分裂 对心力衰竭的研究使我们对患有复杂心理社会问题的患者知之甚少。的 本研究的目的是确定合并症和健康差异的组合可能影响HF结局 需要医疗、心理和社会服务的不同组合来解决。它将包括两个 精神和医学共病，但将强调精神共病的作用。症候群 理论是研究这种心理社会和医学复杂性的有用框架。Syndemics，也 这种疾病被称为协同流行病，当流行疾病之间存在不利的相互作用时， 集中在由于不利的社会经济或环境条件而脆弱的人群中。的 一个综合征框架已经对许多其他疾病产生了重要的见解，但它还没有被使用 研究心衰患者复杂的心理社会问题。据我们所知，这将是第一次研究 心力衰竭的精神和医学共病综合征。多形态框架是一个 研究多种合并症对健康结局影响的替代方法。具体 研究的目的是：1）确定主要精神和医学共病的共患病率， HF住院患者（n=535）; 2）确定共病合并症是否具有协同作用 对30天全因再入院和死亡风险、心力衰竭自我护理和健康相关质量的影响 3）确定HF住院患者中具有较高的 与不太脆弱的亚群相比，共病; 4）确定 并发症可解释HF的不良结局（30天再入院和死亡率、自我护理差， 健康相关生活质量差）; 5）确定 多重吗啡对再入院、死亡风险、自我护理和生活质量的影响。

Approximately 6.2 million Americans have heart failure (HF) and the prevalence is increasing rapidly. HF is a common cause of hospitalization and mortality in older adults, and the cost of hospital care for HF is skyrocketing. One reason why HF is so burdensome and costly is that it is often complicated by cardiovascular and noncardiovascular comorbidities, especially in older patients. Psychiatric and medical disorders that are risk factors for incident HF persist after HF has developed, and additional comorbidities accumulate as patients with HF grow older. Thus, HF is embedded within a larger pattern of multimorbidity. Unfortunately, most trials of HF therapies as well as many other studies of HF have excluded patients with complex psychiatric and medical comorbidities or severe cognitive impairment. This has left large gaps in research on the care of older adults with HF. In addition, research on socioeconomic risk factors and health disparities has not been integrated with research on multimorbidity in HF. Heart failure is only one of multiple challenges facing patients with multimorbidity, stressful socioeconomic circumstances, and psychosocial problems, but the fragmentation of research on HF has left us with little understanding of patients with complex psychosocial problems. The purpose of this study is to identify combinations of comorbidities and health disparities may affect HF outcomes and require different mixtures of medical, psychological, and social services to address. It will encompass both psychiatric and medical comorbidities but will emphasize the role of psychiatric comorbidities. Syndemics theory is a useful framework for studying this type of psychosocial and medical complexity. Syndemics, also known as synergistic epidemics, occur when there are adverse interactions between prevalent disorders that concentrate in populations that are vulnerable due to adverse socioeconomic or environmental conditions. The syndemics framework has yielded important insights into a number of other disorders, but it has not been used to study the complex psychosocial problems of patients with HF. To our knowledge, this will be the first study of the syndemics of psychiatric and medical comorbidities in heart failure. The multimorbidity framework is an alternative approach for investigating the effects of multiple comorbidities on health outcomes. The specific aims of the study are: 1) to determine the coprevalence of major psychiatric and medical comorbidities in hospitalized patients with HF (n=535); 2) to determine whether coprevalent comorbidities have synergistic effects on 30-day all-cause readmission and mortality risks, heart failure self-care, and health-related quality of life; 3) to identify vulnerable subpopulations of hospitalized patients with HF who have higher coprevalences of syndemic comorbidities compared to less vulnerable subpopulations; 4) to determine the extent to which syndemic comorbidities explain adverse HF outcomes (30-day readmissions and mortality, poor self-care, and poor health-related quality of life) in vulnerable subgroups of hospitalized patients with HF; and 5) to determine the effects of multimorbidity on readmissions, mortality risk, self-care, and quality of life.