Tisminetzky Mayra, Gurwitz Jerry, McManus David D, Saczynski Jane S, Erskine Nathaniel, Waring Molly E, Anatchkova Milena, Awad Hamza, Parish David C, Lessard Darleen, Kiefe Catarina, Goldberg Robert
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
Am J Med. 2016 Jun;129(6):608-14. doi: 10.1016/j.amjmed.2015.11.029. Epub 2015 Dec 20.
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.
We studied 2174 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 eight cardiac-related and eight non-cardiac-related morbidities on admission. We assessed multiple psychosocial characteristics during the index hospitalization using standardized in-person instruments.
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 noncardiac 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%).
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.
随着成年人寿命延长，在过去几十年中，多种慢性病变得更加普遍。我们描述了急性冠状动脉综合征后出院患者中心脏相关和非心脏相关多重疾病的患病率及与之相关的患者特征。
我们研究了2011年4月至2013年5月期间在马萨诸塞州和佐治亚州的6个医疗中心因急性冠状动脉综合征出院的2174例患者。医院病历提供了临床信息，包括入院时8种心脏相关和8种非心脏相关疾病的存在情况。我们在索引住院期间使用标准化的面对面工具评估了多种社会心理特征。
研究样本的平均年龄为61岁，67%为男性，81%为非西班牙裔白人。最常见的心脏相关疾病是高血压、高脂血症和糖尿病（分别为76%、69%和31%）。关节炎、慢性肺病和抑郁症（分别为20%、18%和13%）是最常见的非心脏疾病。患有≥4种疾病的患者（占总人群的37%）比患有0 - 1种疾病的患者年龄稍大，女性更常见；他们也更重，更有可能存在认知障碍（26%对12%）、有中度/重度抑郁症状（31%对15%）、感知压力高（48%对32%）、社交网络有限（22%对15%）、健康素养低（42%对31%）和健康算术能力低（54%对42%）。
多重疾病在急性冠状动脉综合征住院患者中非常普遍，与社会心理剥夺指标密切相关。这凸显了护理这些患者的挑战，这远远超出了急性冠状动脉综合征的管理范围。
