Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA.
Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA; School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA.
Curr Probl Cardiol. 2023 Oct;48(10):101881. doi: 10.1016/j.cpcardiol.2023.101881. Epub 2023 Jun 17.
Psychosocial risk factors (PSRFs) are known to be associated with worse cardiovascular (CV) outcomes. However, there are limited data on the impact of PSRFs on readmissions after acute myocardial infarction (AMI) before and during the COVID-19 (Coronavirus Disease 2019) pandemic. Therefore, we aimed to examine this association and whether the effects of PSRFs were amplified during the COVID-19 pandemic. We queried the 2019 and 2020 Nationwide Readmissions Database for adult (age ≥18 years) index admissions with AMI as the primary diagnosis. They were then divided into 2 cohorts based on the presence or absence of ≥1 PSRF and compared across non-COVID-19 (2019) and COVID-19 (2020) time periods. The primary outcome was 30-day all-cause readmissions. Secondary outcomes included cause-specific readmissions (cardiac, noncardiac, AMI, heart failure). Multivariable hierarchical logistic regression was conducted to evaluate differences in outcomes. The study included 380,820 patients with index AMI, of which 214,384 (56%) had ≥1 PSRFs. Patients with PSRFs were younger, more likely to be female, and had a higher prevalence of CV risk factors. Of 30-day all-cause readmissions were higher in patients with PSRFs in both eras. Moreover, noncardiac and heart failure readmissions were also higher in patients with PSRFs admitted with AMI in 2019 and 2020. This study of a nationally representative population magnifies the association of PSRF with more unplanned readmissions after AMI in both pre-COVID-19 and COVID-19 times.
心理社会风险因素（PSRFs）已知与心血管（CV）不良结局相关。然而，在 COVID-19（2019 年冠状病毒病）大流行之前和期间，关于 PSRFs 对急性心肌梗死（AMI）后再入院的影响的数据有限。因此，我们旨在检查这种关联，以及 PSRFs 的影响是否在 COVID-19 大流行期间放大。我们在 2019 年和 2020 年全国再入院数据库中查询了以 AMI 为主要诊断的成人（年龄≥18 岁）索引入院的病例。然后，根据是否存在≥1 个 PSRF 将他们分为 2 个队列，并在非 COVID-19（2019 年）和 COVID-19（2020 年）时期进行比较。主要结果是 30 天全因再入院。次要结果包括特定原因的再入院（心脏、非心脏、AMI、心力衰竭）。采用多变量层次逻辑回归评估结局差异。研究纳入了 380820 例 AMI 索引患者，其中 214384 例（56%）存在≥1 个 PSRFs。有 PSRFs 的患者更年轻，更可能为女性，且 CV 危险因素的发生率更高。在两个时期，有 PSRFs 的患者 30 天全因再入院率更高。此外，在 2019 年和 2020 年，有 PSRFs 的 AMI 入院患者的非心脏和心力衰竭再入院率也更高。这项全国代表性人群的研究放大了 PSRFs 与 AMI 后更多非计划性再入院之间的关联，无论是在 COVID-19 之前还是期间。
Zotero 插件