Abstract 13005: Psychological Stress and 30-day Readmission in Acute Coronary Syndrome Patients
A “post-hospital syndrome,” due in part to the stress caused by hospitalization, has been proposed to explain the high risk for 30-day readmission after acute cardiac events. We tested this hypothesis by examining if acute coronary syndrome (ACS) patients who report high stress during and immediately after hospitalization are at increased risk for 30-day rehospitalization.
Consecutively hospitalized ACS patients were recruited from Columbia University Medical Center within 1 week of admission. Patients reported their stress level during and after hospitalization by telephone interview after discharge (mean 8.5 days), using a single item, “During the past two weeks, how often have you felt tense or “wound up.” Responses were dichotomized (“often” or “most of the time”= 1; “rarely” or “never”= 0). All-cause 30-day rehospitalization was determined by follow-up telephone calls to patients and confirmed by hospital records.
Participants were 342 ACS patients, (mean age 62, 35% women, 24% Black/African American, 40% Hispanic, GRACE= 91.6 (29.2), Charlson= 1.6 (1.7), 15% LVEF≤ 40). Twenty-two patients (6.4%) reported high stress. In total, 39 (11.4%) were rehospitalized within 30 days. Rehospitalization within 30 days was more common in patients with high stress (5 events, 23%) than in patients with low stress (35 events, 11%). 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 after adjustment for demographics, Global Registry of Acute Coronary Events (GRACE) risk score,3 Charlson comorbidity index,4 baseline left ventricular ejection fraction (LVEF), and depression symptoms (HR= 3.21, 95% CI= 1.13, 9.10; Figure).
This is the first study documenting the role of stress during index hospitalization in the “post-hospital syndrome,” and it suggests that stress during hospitalization may be a target for intervention to reduce 30-day rehospitalizations.
- © 2013 by American Heart Association, Inc.