Multiple Chronic Conditions and Psychosocial Limitations in a Contemporary Cohort of Patients Hospitalized With an Acute Coronary Syndrome

Authors

Mayra Tisminetzky, University of Massachusetts Medical School; Meyers Primary Care InstituteFollow
Jerry Gurwitz, University of Massachusetts Medical School; Meyers Primary Care Institute
David D. McManus, University of Massachusetts Medical School; Meyers Primary Care Institute
Jane S. Saczynski, University of Massachusetts Medical School; Meyers Primary Care Institute
Molly E. Waring, University of Massachusetts Medical School
Nathaniel Erskine, University of Massachusetts Medical School
Milena Anatchkova, University of Massachusetts Medical School
David C. Parish, Mercer University School of Medicine
Darleen Lessard, University of Massachusetts Medical School
Catarina Kiefe, University of Massachusetts Medical School
Robert Goldberg, University of Massachusetts Medical School; Meyers Primary Care Institute

Publication Date

8-15-2016

Keywords

multimorbidity, acute coronary syndrome

Abstract

Background/Aims: As adults live longer, multiple chronic conditions have become more prevalent over the past several decades. We describe the prevalence of and patient characteristics associated with cardiac and noncardiac-related multimorbidities in patients discharged from the hospital after an acute coronary syndrome.

Methods: We studied 2,174 patients discharged from the hospital after an acute coronary syndrome at six medical centers in Massachusetts and Georgia between April 2011 and May 2013. Hospital medical records yielded clinical information, including presence of 8 cardiac-related and 8 noncardiac-related morbidities on admission. We assessed multiple psychosocial characteristics during the index hospitalization using standardized in-person instruments.

Results: The mean age of the study sample was 61 years, 67% were men, and 81% were non-Hispanic whites. The most common cardiac-related morbidities were hypertension, hyperlipidemia and diabetes (76%, 69% and 31%, respectively). Arthritis, chronic pulmonary disease and depression (20%, 18% and 13%, respectively) were the most common noncardiac morbidities. Patients with 4 or more morbidities (37% of the population) were slightly older and more likely to be women than those with 0–1 morbidity; they were also heavier and more likely to be cognitively impaired (26% vs. 12%), have symptoms of moderate/severe depression (31% vs. 15%), have high perceived stress (48% vs. 32%), have a limited social network (22% vs. 15%), have low health literacy (42% vs. 31%) and have low health numeracy (54% vs. 42%).

Conclusion: Multimorbidity –– highly prevalent in patients hospitalized with an acute coronary syndrome –– is associated with psychosocial characteristics. This emphasizes the challenge of caring for these patients, which extends well beyond acute coronary syndrome management.

Recommended Citation

Tisminetzky M, Gurwitz J, McManus DD, Saczynski JS, Waring ME, Erskine N, Anatchkova M, Parish DC, Lessard D, Kiefe C, Goldberg R. Multiple chronic conditions and psychosocial limitations in a contemporary cohort of patients hospitalized with an acute coronary syndrome. J Patient Cent Res Rev. 2016;3:169-70.