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美国急性心肌梗死后的精神健康障碍和再入院问题。

Mental health disorders and readmissions following acute myocardial infarction in the United States.

机构信息

Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA.

Department of Cardiology, University of Mississippi Medical Center, Jackson, MS, USA.

出版信息

Sci Rep. 2022 Feb 28;12(1):3327. doi: 10.1038/s41598-022-07234-z.

Abstract

Hospital readmissions following an acute myocardial infarction (MI) are associated with increased mortality and morbidity. The aim of this study was to investigate if there is a significant association between specific mental health disorders (MHD) and risk of hospital readmission after an index hospitalization for acute MI. We analyzed the U.S. National Readmission Database for adult acute MI hospitalizations from 2016 to 2017. Co-morbid diagnoses of MHD were obtained using appropriate ICD-10-CM diagnostic codes. The primary outcome of interest was 30-day all-cause unplanned readmission. Cox-regression analysis was used to identify the association of various MHD and risk of 30-day readmission adjusted for demographics, medical and cardiac comorbidities, and coronary revascularization. We identified a total of 1,045,752 hospitalizations for acute MI; patients had mean age of 67 ± 13 years with 37.6% female. The prevalence of any MHD was 15.0 ± 0.9%. After adjusting for potential confounders, comorbid diagnosis of major depression [HR 1.11 (95% CI 1.07-1.15)], bipolar disorders [1.32 (1.19-1.45)], anxiety disorders [1.09 (1.05-1.13)] and schizophrenia/other psychotic disorders [1.56 (1.43-1.69)] were independently associated with higher risk of 30-day readmission compared to those with no comorbid MHD. We conclude that MHD are significantly associated with a higher independent risk of 30-day all-cause hospital readmissions among acute MI hospitalizations.

摘要

急性心肌梗死(MI)后再次住院与死亡率和发病率增加有关。本研究旨在探讨特定精神健康障碍(MHD)与急性 MI 指数住院后再次住院风险之间是否存在显著关联。我们分析了 2016 年至 2017 年美国国家再入院数据库中成人急性 MI 住院患者的数据。使用适当的 ICD-10-CM 诊断代码获取 MHD 的合并诊断。主要观察指标为 30 天全因非计划性再入院。使用 Cox 回归分析来确定各种 MHD 与 30 天再入院风险的关联,调整了人口统计学、医疗和心脏合并症以及冠状动脉血运重建。我们共确定了 1045752 例急性 MI 住院患者;患者的平均年龄为 67±13 岁,其中 37.6%为女性。任何 MHD 的患病率为 15.0±0.9%。在调整了潜在混杂因素后,合并诊断为重度抑郁症[HR 1.11(95%CI 1.07-1.15)]、双相障碍[1.32(1.19-1.45)]、焦虑症[1.09(1.05-1.13)]和精神分裂症/其他精神病障碍[1.56(1.43-1.69)]与无合并 MHD 的患者相比,30 天再入院的风险更高。我们得出结论,MHD 与急性 MI 住院患者 30 天全因再入院的独立高风险显著相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f33e/8885687/27200f297f24/41598_2022_7234_Fig1_HTML.jpg

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