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)，而且患病率正在迅速上升。HF是一种 老年人住院和死亡的常见原因，心力衰竭的住院护理费用为 飞涨。心力衰竭如此繁重和昂贵的原因之一是它经常合并心血管疾病 以及非心血管并发症，特别是在老年患者中。精神疾病和内科疾病 发生心力衰竭的危险因素在心力衰竭发生后仍然存在，随着患者的发展，更多的合并症会积累起来。 随着心力衰竭年龄的增长。因此，心力衰竭嵌入了更大的多发病模式。不幸的是，大多数试验 以及许多其他关于心力衰竭的研究排除了患有复杂精神疾病和 内科合并症或严重的认知障碍。这在老年人护理方面的研究留下了很大的空白 患有心力衰竭的成年人。此外，对社会经济风险因素和健康差距的研究尚未得到 与心衰多病的研究相结合。心力衰竭只是患者面临的多重挑战之一 患有多发病、紧张的社会经济环境和心理社会问题，但 对心力衰竭的研究使我们对有复杂心理社会问题的患者了解很少。这个 这项研究的目的是确定合并症和健康差异可能影响心力衰竭的结局。 并需要医疗、心理和社会服务的不同组合来解决。它将包括这两个方面 精神和医学并存，但将强调精神并存的作用。Syndemics 理论是研究这种心理社会和医学复杂性的有用框架。Syndemics，也是 当流行的疾病之间存在不利的相互作用时，就会发生称为协同流行病 集中在因不利的社会经济或环境条件而易受伤害的人群。这个 Syndemics框架已经对其他一些障碍产生了重要的见解，但它还没有被使用 目的研究心力衰竭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合并症的综合症状。多发病框架是一种 研究多种合并症对健康结果影响的替代方法。具体的 这项研究的目的是：1)确定主要精神疾病和医学合并症在 心力衰竭住院患者(n=)；2)确定共生共病是否具有协同作用 对30天全因再入院和死亡风险、心力衰竭自我护理以及与健康相关的质量的影响 生命；3)确定心力衰竭住院患者的易患亚群 合并症与不那么脆弱的亚群的比较；4)确定 合并症可解释不良心力衰竭结局(30天再入院和死亡率、自理能力差和 与健康相关的生活质量差)；以及5)确定 多发病对再入院、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.