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Gender-specific secondary prevention? Differential psychosocial risk factors for major cardiovascular events.

Kure CE, Chan YK, Ski CF, Thompson DR, Carrington MJ, Stewart S - Open Heart (2016)

Bottom Line: During 2-year follow-up, 165 (27%) participants (114 men, 51 women; p=0.431) experienced a MACE.Independent correlates of a MACE in men were depressive status (OR 1.95, 95% CI 1.06 to 3.58; p=0.032), low physical HRQoL (OR 0.98, 95% CI 0.96 to 1.00; p=0.027) and increasing comorbidity (OR 1.14, 95% CI 1.04 to 1.25; p=0.004).In women, age (OR 1.06, 95% CI 1.02 to 1.12; p=0.008), MCI (OR 2.38, 95% CI 1.09 to 5.18; p=0.029) and hospital site predicted a MACE (OR 2.32, 95% CI 1.09 to 4.93; p=0.029).

View Article: PubMed Central - PubMed

Affiliation: Mary MacKillop Institute for Health Research, Australian Catholic University , Melbourne, Victoria , Australia.

ABSTRACT

Objective: To explore the psychosocial determinants and interhospital variability on a major acute cardiovascular event (MACE), during follow-up of a multicenter cohort of patients hospitalised with heart disease, participating in a nurse-led secondary prevention programme.

Methods: Outcome data were retrospectively analysed from 602 cardiac inpatients randomised to postdischarge standard care (n=296), or home-based intervention (n=306), with prolonged follow-up of individualised multidisciplinary support. Baseline psychosocial profiling comprised depressive status, health-related quality of life (HRQoL), social isolation and mild cognitive impairment (MCI). Multivariate analyses examined the independent correlates of a composite 2-year MACE rate of all-cause mortality and unplanned cardiovascular-related hospitalisation, according to gender.

Results: Participants were aged 70±10 years, 431 (72%) were men and 377 (63%) had coronary artery disease. During 2-year follow-up, 165 (27%) participants (114 men, 51 women; p=0.431) experienced a MACE. Independent correlates of a MACE in men were depressive status (OR 1.95, 95% CI 1.06 to 3.58; p=0.032), low physical HRQoL (OR 0.98, 95% CI 0.96 to 1.00; p=0.027) and increasing comorbidity (OR 1.14, 95% CI 1.04 to 1.25; p=0.004). In women, age (OR 1.06, 95% CI 1.02 to 1.12; p=0.008), MCI (OR 2.38, 95% CI 1.09 to 5.18; p=0.029) and hospital site predicted a MACE (OR 2.32, 95% CI 1.09 to 4.93; p=0.029).

Conclusions: Psychological determinants, cognitive impairment and responses to secondary prevention are different for men and women with heart disease and appear to modulate cardiovascular-specific outcomes. Early detection of psychosocial factors through routine screening and gender-specific secondary prevention is encouraged.

Trial registration number: 12608000014358.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier event-free survival from a major acute cardiovascular event in women (A) and men (B), according to group randomisation and hospital enrolment.
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OPENHRT2015000356F1: Kaplan-Meier event-free survival from a major acute cardiovascular event in women (A) and men (B), according to group randomisation and hospital enrolment.

Mentions: There were notable differences in the overall pattern of 2-year MACE according to hospital site (24% from Hospital-A vs 30% from Hospital-B), however, it was not statistically significant (p=0.073). Proportionately, more women than men from Hospital-B experienced a MACE, although this was of borderline significance (38% vs 27%, log-rank χ2=3.8, p=0.052). Further, significantly more women from Hospital-A in the standard care group experienced a MACE (33% vs 12%; p=0.028). There was a similar (not significant) trend in women receiving HBI (43% vs 25%; p=0.064; figure 1A) and no significant differences in men (HBI, p=0.553; standard care, p=0.888; figure 1B).


Gender-specific secondary prevention? Differential psychosocial risk factors for major cardiovascular events.

Kure CE, Chan YK, Ski CF, Thompson DR, Carrington MJ, Stewart S - Open Heart (2016)

Kaplan-Meier event-free survival from a major acute cardiovascular event in women (A) and men (B), according to group randomisation and hospital enrolment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836286&req=5

OPENHRT2015000356F1: Kaplan-Meier event-free survival from a major acute cardiovascular event in women (A) and men (B), according to group randomisation and hospital enrolment.
Mentions: There were notable differences in the overall pattern of 2-year MACE according to hospital site (24% from Hospital-A vs 30% from Hospital-B), however, it was not statistically significant (p=0.073). Proportionately, more women than men from Hospital-B experienced a MACE, although this was of borderline significance (38% vs 27%, log-rank χ2=3.8, p=0.052). Further, significantly more women from Hospital-A in the standard care group experienced a MACE (33% vs 12%; p=0.028). There was a similar (not significant) trend in women receiving HBI (43% vs 25%; p=0.064; figure 1A) and no significant differences in men (HBI, p=0.553; standard care, p=0.888; figure 1B).

Bottom Line: During 2-year follow-up, 165 (27%) participants (114 men, 51 women; p=0.431) experienced a MACE.Independent correlates of a MACE in men were depressive status (OR 1.95, 95% CI 1.06 to 3.58; p=0.032), low physical HRQoL (OR 0.98, 95% CI 0.96 to 1.00; p=0.027) and increasing comorbidity (OR 1.14, 95% CI 1.04 to 1.25; p=0.004).In women, age (OR 1.06, 95% CI 1.02 to 1.12; p=0.008), MCI (OR 2.38, 95% CI 1.09 to 5.18; p=0.029) and hospital site predicted a MACE (OR 2.32, 95% CI 1.09 to 4.93; p=0.029).

View Article: PubMed Central - PubMed

Affiliation: Mary MacKillop Institute for Health Research, Australian Catholic University , Melbourne, Victoria , Australia.

ABSTRACT

Objective: To explore the psychosocial determinants and interhospital variability on a major acute cardiovascular event (MACE), during follow-up of a multicenter cohort of patients hospitalised with heart disease, participating in a nurse-led secondary prevention programme.

Methods: Outcome data were retrospectively analysed from 602 cardiac inpatients randomised to postdischarge standard care (n=296), or home-based intervention (n=306), with prolonged follow-up of individualised multidisciplinary support. Baseline psychosocial profiling comprised depressive status, health-related quality of life (HRQoL), social isolation and mild cognitive impairment (MCI). Multivariate analyses examined the independent correlates of a composite 2-year MACE rate of all-cause mortality and unplanned cardiovascular-related hospitalisation, according to gender.

Results: Participants were aged 70±10 years, 431 (72%) were men and 377 (63%) had coronary artery disease. During 2-year follow-up, 165 (27%) participants (114 men, 51 women; p=0.431) experienced a MACE. Independent correlates of a MACE in men were depressive status (OR 1.95, 95% CI 1.06 to 3.58; p=0.032), low physical HRQoL (OR 0.98, 95% CI 0.96 to 1.00; p=0.027) and increasing comorbidity (OR 1.14, 95% CI 1.04 to 1.25; p=0.004). In women, age (OR 1.06, 95% CI 1.02 to 1.12; p=0.008), MCI (OR 2.38, 95% CI 1.09 to 5.18; p=0.029) and hospital site predicted a MACE (OR 2.32, 95% CI 1.09 to 4.93; p=0.029).

Conclusions: Psychological determinants, cognitive impairment and responses to secondary prevention are different for men and women with heart disease and appear to modulate cardiovascular-specific outcomes. Early detection of psychosocial factors through routine screening and gender-specific secondary prevention is encouraged.

Trial registration number: 12608000014358.

No MeSH data available.


Related in: MedlinePlus