16 A Mixed methods Study Investigating Readmission, Symptom Attribution and Psychological Health in Primary Percutaneous Coronary Intervention (PPCI) Patients

Abstract

Introduction Following ST-elevation myocardial infarction (STEMI) and treatment with PPCI, some patients are readmitted with potential ischaemic heart disease (p-IHD) symptoms. Symptoms may be related to cardiac ischaemia, reduced psychological health or a comorbid condition, all sharing similar symptoms. The purpose of the study was to investigate the proportion of PPCI patients readmitted due to p-IHD symptoms within 6 months of STEMI, and to explore associated factors. Methods A mixed methods prospective study, which included questionnaires: Seattle Angina Questionnaire (SAQ), the Hospital and Anxiety and Depression Scale (HADS) at 0 and 6 months; clinical data: Global Registry of Acute Coronary Events (GRACE) and Charleson Comorbidity Index (CCI) at baseline; readmission data collected using patient records and telephone interview at 6 months; qualitative data collected purposefully through semi-structured interviews at 6 months. Results 202 PPCI patients returned baseline questionnaires [mean age 59.7 yrs (SD 13.9), 75.7% male]; 38 (18.8%; 95% CI 14.0% to 24.8%) participants were readmitted due to p-IHD symptoms at 6 months; 16 (42.1%) due to a cardiac event and 22 (57.9%) did not receive a diagnosis. At both baseline and 6 months, mean HADS anxiety scores were higher for the readmission group compared to the non-readmission group (baseline 9.5 vs 7.1, p = 0.006; 6 months 9.4 vs 6.0, p Conclusion Elevated levels of anxiety at baseline were predictive of readmission with p-IHD symptoms at 6 months. Factors such as shock at experiencing a STEMI, hypervigilance of symptoms and difficulty with symptom attribution appeared to play a role in raised anxiety levels for the readmission group. Findings suggested that changes are needed to cardiac rehabilitation and post-STEMI follow-up to address educational needs and psychological issues.