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.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21HL108187-02
Application #
8311625
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Czajkowski, Susan
Project Start
2011-08-05
Project End
2013-10-30
Budget Start
2012-05-01
Budget End
2013-10-30
Support Year
2
Fiscal Year
2012
Total Cost
$164,500
Indirect Cost
$64,500
Name
University of Massachusetts Medical School Worcester
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
603847393
City
Worcester
State
MA
Country
United States
Zip Code
01655