University of Massachusetts Medical School Faculty Publications

Title

Multiple Chronic Conditions and Psychosocial Limitations in Patients Hospitalized with an Acute Coronary Syndrome

UMMS Affiliation

Department of Quantitative Health Sciences; Department of Medicine, Division of Cardiovascular Medicine; Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine

Date

12-20-2015

Document Type

Article

Disciplines

Cardiology | Cardiovascular Diseases | Geriatrics

Abstract

BACKGROUND: As adults live longer, multiple chronic conditions have become more prevalent over the past several decades. We describe the prevalence of, and patient characteristics associated with, cardiac and non-cardiac-related multimorbidities in patients discharged from the hospital after an acute coronary syndrome.

METHODS: We studied 2,174 patients discharged from the hospital after an acute coronary syndrome at 6 medical centers in Massachusetts and Georgia between April, 2011 and May, 2013. Hospital medical records yielded clinical information including presence of 8 cardiac-related and 8 non-cardiac-related morbidities on admission. We assessed multiple psychosocial characteristics during the index hospitalization using standardized in-person instruments.

RESULTS: The mean age of the study sample was 61 years, 67% were men, and 81% were non-Hispanic whites. The most common cardiac-related morbidities were hypertension, hyperlipidemia, and diabetes (76%, 69%, and 31%, respectively). Arthritis, chronic pulmonary disease, and depression (20%, 18%, and 13%, respectively) were the most common non-cardiac morbidities. Patients with ≥4 morbidities (37% of the population) were slightly older and more frequently female than those with 0-1 morbidity; they were also heavier and more likely to be cognitively impaired (26% vs. 12%), have symptoms of moderate/severe depression (31% vs. 15%), high perceived stress (48% vs. 32%), a limited social network (22% vs. 15%), low health literacy (42% vs. 31%), and low health numeracy (54% vs. 42%).

CONCLUSIONS: Multimorbidity, highly prevalent in patients hospitalized with an acute coronary syndrome, is strongly associated with indices of psychosocial deprivation. This emphasizes the challenge of caring for these patients, which extends well beyond acute coronary syndrome management.

Comments

Citation: Tisminetzky M, Gurwitz J, McManus DD, Saczynski JS, Erskine N, Waring ME, Anatchkova M, Awad H, Parish DC, Lessard D, Kiefe C, Goldberg R. Multiple Chronic Conditions and Psychosocial Limitations in Patients Hospitalized with an Acute Coronary Syndrome. Am J Med. 2015 Dec 20. pii: S0002-9343(15)30028-0. doi:10.1016/j.amjmed.2015.11.029. [Epub ahead of print] PubMed PMID: 26714211. Link to article on publisher's website

Related Resources

Link to article in PubMed

Keywords

UMCCTS funding

PubMed ID

26714211