About 1.2 million Americans are hospitalized annually with acute coronary syndrome (ACS), and most are discharged alive. Although post-ACS mortality and clinical morbidity have been improving patients may be living longer but not better. In fact, many patients suffer substantial declines in quality of life and functional status after discharge with ACS. Because of critical gaps in our understanding how health status evolves over time for ACS patients, important opportunities for prevention and intervention are potentially being missed. The proposed research takes a systematic approach to examining the association of demographic, psychosocial, clinical, and neighborhood factors on trajectories of health-related quality of life after discharge for ACS. Our study will leverage the availability of rich data already collected for the NHLBI-funded TRACE- CORE, a longitudinal prospective cohort study of 2,183 patients hospitalized with ACS. This study includes data from interview, medical record abstraction, linked administrative databases, and geo-coded census tracks.
Specific aims are to: (1) Determine associations between individual level socio-economic, clinical, in- hospital and psychosocial factors and trajectories of patient health status post-ACS discharge, both generic (SF-36) and disease specific (Seattle Angina Questionnaire with domains of physical limitations, angina stability, angina frequency, treatment satisfaction and angina specific quality of life); (2) Determine how neighborhood deprivation is associated with trajectories of patient health status; and (3) Identify the extent to which trajectories of generic quality of life and disease-specific quality of life at baseline, one month, 3 months and 6 months predict mortality or readmission 6 months to 1 year post-ACS discharge. This pre-doctoral fellowship proposal also includes a carefully training plan for me to become an independent physician scientist able to fully exploit the potential of patient-reported outcomes to improve the lives of patients with cardiovascular disease.

Public Health Relevance

About 1.2 million Americans are hospitalized annually with acute coronary syndrome (ACS), and most are discharged alive. Unfortunately, there is little information about changes in patients' quality of life during the 6 months after leaving the hospital. This study will describe the groups of patients having distinctly different changes in quality of life after a heart attack, the factors that predict these particular changes, and what these patterns in quality of life changes mean in terms of potential bad events in their future.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Individual Predoctoral NRSA for M.D./Ph.D. Fellowships (ADAMHA) (F30)
Project #
5F30HL128012-02
Application #
9049279
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Kaufmann, Peter G
Project Start
2015-04-01
Project End
2019-03-31
Budget Start
2016-04-01
Budget End
2017-03-31
Support Year
2
Fiscal Year
2016
Total Cost
Indirect Cost
Name
University of Massachusetts Medical School Worcester
Department
Other Health Professions
Type
Schools of Medicine
DUNS #
603847393
City
Worcester
State
MA
Country
United States
Zip Code
Nobel, Lisa; Jesdale, William M; Tjia, Jennifer et al. (2017) Neighborhood Socioeconomic Status Predicts Health After Hospitalization for Acute Coronary Syndromes: Findings From TRACE-CORE (Transitions, Risks, and Actions in Coronary Events-Center for Outcomes Research and Education). Med Care 55:1008-1016
Nobel, Lisa; Roblin, Douglas W; Becker, Edmund R et al. (2017) Index of cardiometabolic health: a new method of measuring allostatic load using electronic health records. Biomarkers 22:394-402
Chin, Michael S; Babchenko, Oksana; Lujan-Hernandez, Jorge et al. (2015) Hyperspectral Imaging for Burn Depth Assessment in an Animal Model. Plast Reconstr Surg Glob Open 3:e591