GSBS Dissertations and Theses

ORCID ID

0000-0002-9625-3592

Approval Date

3-24-2017

Document Type

Doctoral Dissertation

Academic Program

Clinical and Population Health Research, MD/PhD

Department

Quantitative Health Sciences

First Thesis Advisor

Jeroan J. Allison

Keywords

acute coronary syndrome, ACS, quality of life, patient health status, PHS, predictions, socioeconomic status, SES, TRACE-CORE

Abstract

More than 1.2 million Americans are hospitalized annually with an acute coronary syndrome (ACS); many impaired quality of life after discharge with an ACS. This dissertation focuses on two novel aspects of patient health status (PHS) after ACS: how it can be predicted based on the socioeconomic status (SES) of the patient, and how it evolves over time. We used data from TRACE-CORE, a longitudinal prospective cohort of patients hospitalized with ACS. We measured PHS using both the SF-36 mental and physical component subscales (MCS and PCS) and the Seattle Angina Questionnaire (SAQ) health-related quality of life (HRQoL) and physical limitations subscales at the index hospitalization and at 1, 3, and 6-months post-discharge. Firstly, after adjusting for individual-level SES, we found that individuals living in the neighborhoods with the lowest neighborhood SES had significantly worse PHS. Secondly, we found that each of the components of PHS had subgroups with distinct patterns of evolution over time (trajectories). Both the PCS and the SAQ physical limitations subscale had two trajectories; one with average and one with impaired health status over time. For the HRQoL subscale of SAQ, we found three trajectories: Low, Average, and High scores. For MCS, we found four trajectories: High (consistently high scores), Low (consistently low scores), and two with average scores at baseline that either improved or worsened over time, referred to as Improving and Worsening, respectively. All PHS trajectories, except for MCS, predicted readmission and mortality during the 6 months to 1 year post-ACS discharge.

DOI

10.13028/M2MQ1B

Rights and Permissions

Copyright is held by the author, with all rights reserved.

Available for download on Thursday, August 01, 2019

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