Abstract MP078: Are Patients With Less Activation at Greater Risk of Declines in Health-related Quality of Life After Hospitalization for an Acute Coronary Syndrome?

Abstract

Background: Patient activation comprises the knowledge, skills, and confidence for self-care, and may lead to better health outcomes. Hypothesis: We hypothesized that less-activated survivors of a hospitalization for an acute coronary syndrome (ACS) would be more likely to experience declines in health-related quality of life than more activated patients. Methods: We studiedpatients from 6 medical centers in central Massachusetts and Georgia who had been hospitalized for an ACS between 2011 and 2013. At 1 month after hospital discharge, patients completed the 6-item Patient Activation Measure and at 1, 3, and 6 months after discharge generic physical (SF-36 PCS), generic mental (SF-36 MCS), and disease-specific (SAQ - Seattle Angina Questionnaire) health-related quality of life (QOL) scales. Four categories of 1-month activation levels were defined. Multinomial logistic regression estimated odds ratios were calculated for clinically meaningful changes in QOL, with patients in the highest level of activation serving as the referent group, adjusting for sociodemographic and clinical confounders. Results: Patients (n=1,042) were on average 62 years old, 34% were female, and 87% were non-Hispanic white; 10% and 29% of patients were in the lowest and highest levels of activation, respectively. Higher proportions of patients in the least activated group vs. the most activated group tended to experience clinically meaningful declines in QOL, for all scales and both follow-up periods (Table). Least activated patients had significantly higher adjusted odds of experiencing clinically meaningful declines in MCS and SAQ scores from 1 to 6 months after hospital discharge, but not PCS scores, with a similar pattern observed between 1 and 3 months after hospital discharge. Conclusions: Following hospitalization for an ACS, patients with low activation may be more likely to have declines in mental and disease-specific health-related QOL than highly activated patients, identifying a group at high risk of poor outcomes.