Allison T G, Williams D E, Miller T D, Patten C A, Bailey K R, Squires R W, Gau G T
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, Minnesota 55905, USA.
Mayo Clin Proc. 1995 Aug;70(8):734-42. doi: 10.4065/70.8.734.
To determine the effect of psychologic distress, measured with a commonly used screening questionnaire, on 6-month morbidity and rehospitalization costs in coronary patients.
Psychologic distress was determined by screening with the Symptom Checklist-90--Revised (SCL-90-R) self-report inventory during the second week of cardiac rehabilitation. Costs associated with cardiovascular rehospitalization during a 6-month follow-up period were recorded, and differences between "distressed" and "nondistressed" patients were analyzed statistically.
The study cohort consisted of 381 patients (311 men and 70 women) referred for cardiac rehabilitation after an index hospitalization for unstable angina, myocardial infarction, coronary angioplasty, or coronary bypass procedure. Patients with SCL-90-R scores above the 90th percentile for outpatient adults were considered distressed (N = 41); patients with scores below this level were considered nondistressed (N = 340).
The 6-month follow-up was complete in all but 1 of the 381 patients. Distressed patients had significantly higher rates of cardiovascular rehospitalization, any recurrent events, and recurrent "hard events" (cardiac death, myocardial infarction, or cardiac arrest and resuscitation) within 6 months after dismissal from their index hospitalization in comparison with nondistressed patients. Adjustment for other factors associated with a risk of early rehospitalization and recurrent events did not reduce the strength or significance of the association between psychologic distress and early cardiovascular rehospitalization or recurrent events. The mean rehospitalization costs were significantly higher in the distressed than in the nondistressed patients ($9,504 versus $2,146).
These data add support to the hypothesis that psychologic distress adversely affects the prognosis in coronary patients, confirm the added morbidity and rehospitalization costs attributable to psychologic distress, and suggest the potential for improving the prognosis in selected coronary patients by identification and appropriate treatment of psychologic distress.
使用常用筛查问卷测定心理困扰对冠心病患者6个月发病率及再住院费用的影响。
在心脏康复的第二周，通过症状自评量表90修订版（SCL-90-R）自我报告问卷筛查心理困扰。记录6个月随访期内心血管再住院相关费用，并对“困扰”和“非困扰”患者之间的差异进行统计学分析。
研究队列包括381例患者（311例男性和70例女性），这些患者因不稳定型心绞痛、心肌梗死、冠状动脉成形术或冠状动脉搭桥手术首次住院后被转诊接受心脏康复治疗。门诊成年患者SCL-90-R评分高于第90百分位数的患者被视为困扰患者（N = 41）；评分低于此水平的患者被视为非困扰患者（N = 340）。
381例患者中除1例患者外，其余患者均完成了6个月的随访。与非困扰患者相比，困扰患者在首次住院出院后6个月内发生心血管再住院、任何复发事件以及复发“严重事件”（心源性死亡、心肌梗死或心脏骤停及复苏）的发生率显著更高。对与早期再住院和复发事件风险相关的其他因素进行调整后，并未降低心理困扰与早期心血管再住院或复发事件之间关联的强度或显著性。困扰患者的平均再住院费用显著高于非困扰患者（9504美元对2146美元）。
这些数据支持了心理困扰对冠心病患者预后产生不利影响的假设，证实了心理困扰导致的额外发病率和再住院费用，并表明通过识别和适当治疗心理困扰，有可能改善特定冠心病患者的预后。
