Abstract
BackgroundMany acute coronary syndrome (ACS; myocardial infarction and unstable angina) patients are rehospitalized within 30 days of discharge, and recent US health policy initiatives have tied hospital Medicare reimbursement to 30-day readmission rates. Patient-perceived psychological stress is thought to impact prognosis after ACS. A recently offered “posthospital syndrome” model of 30-day readmissions posits that the stress level at the time of the index hospitalization itself may increase 30-day risk for readmission in ACS patients. We tested whether self-reported stress in the days surrounding the ACS hospitalization was associated with increased risk for readmission within 30 days.MethodsA mean of 8.5 days after discharge, 342 consecutively hospitalized ACS patients reported on how often they felt stress during the past two weeks. Readmission within 30 days of hospital discharge for any cause was determined by follow-up telephone calls to patients and confirmed by hospital records.ResultsOverall, 40 (11.7%) participants were readmitted within 30 days, and 22 (6.4%) reported high stress. Readmission within 30 days was more common in patients with high stress (5 admissions, 23%) than in patients with low stress (35 admissions, 11%). After adjustment for demographic and clinical factors, as well as depression, high stress was associated with a 3-fold increased risk of 30-day readmission (HR = 3.21, 95% CI = 1.13, 9.10).ConclusionsPrevious research has shown that stress in the days surrounding a hospitalization can mark long-term cardiovascular risk, but this is the first study to test a hypothesis of the posthospital syndrome model of early readmission. Further research is needed to confirm the association between stress and readmission risk, and to identify the processes of hospitalization that could be modified to both reduce the stress experienced and that would also be effective for reducing readmissions.
Highlights
Within the first 30 days of discharge from the hospital for an acute myocardial infarction (MI), 1 out of every 5 patients aged 65 years and older are readmitted [1]
High stress during index hospitalization was associated with increased risk for early rehospitalization in both unadjusted (HR = 2.29, 95% CI = 0.90, 5.86) and fully adjusted models (HR = 3.21, 95% CI = 1.13, 9.10; Figure 1)
To explore whether the stress that participants reported was associated in part with the hospitalization itself, we calculated the correlation between the stress item and self-reported intrusive thoughts about the acute coronary syndrome (ACS) hospitalization 1 month later using the intrusions subscale of the Impact of Events Scale-Revised (IES-R), keyed to the ACS hospitalization [10]
Summary
Within the first 30 days of discharge from the hospital for an acute myocardial infarction (MI), 1 out of every 5 patients aged 65 years and older are readmitted [1]. This high proportion of readmissions has led federal policy makers to include a provision in the Affordable Care Act that reduces Medicare payments to hospitals based on their 30 day readmission rate. Many acute coronary syndrome (ACS; myocardial infarction and unstable angina) patients are rehospitalized within 30 days of discharge, and recent US health policy initiatives have tied hospital Medicare reimbursement to 30-day readmission rates. We tested whether self-reported stress in the days surrounding the ACS hospitalization was associated with increased risk for readmission within 30 days
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