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Gender-specific secondary prevention? Differential psychosocial risk factors for major cardiovascular events

机译：针对性别的二级预防？重大心血管事件的不同社会心理风险因素

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Objective To explore the psychosocial determinants and interhospital variability on a major acute cardiovascular event (MACE), during follow-up of a multicenter cohort of patients hospitalised with heart disease, participating in a nurse-led secondary prevention programme. Methods Outcome data were retrospectively analysed from 602 cardiac inpatients randomised to postdischarge standard care (n=296), or home-based intervention (n=306), with prolonged follow-up of individualised multidisciplinary support. Baseline psychosocial profiling comprised depressive status, health-related quality of life (HRQoL), social isolation and mild cognitive impairment (MCI). Multivariate analyses examined the independent correlates of a composite 2-year MACE rate of all-cause mortality and unplanned cardiovascular-related hospitalisation, according to gender. Results Participants were aged 70±10?years, 431 (72%) were men and 377 (63%) had coronary artery disease. During 2-year follow-up, 165 (27%) participants (114 men, 51 women; p=0.431) experienced a MACE. Independent correlates of a MACE in men were depressive status (OR 1.95, 95% CI 1.06 to 3.58; p=0.032), low physical HRQoL (OR 0.98, 95% CI 0.96 to 1.00; p=0.027) and increasing comorbidity (OR 1.14, 95% CI 1.04 to 1.25; p=0.004). In women, age (OR 1.06, 95% CI 1.02 to 1.12; p=0.008), MCI (OR 2.38, 95% CI 1.09 to 5.18; p=0.029) and hospital site predicted a MACE (OR 2.32, 95% CI 1.09 to 4.93; p=0.029). Conclusions Psychological determinants, cognitive impairment and responses to secondary prevention are different for men and women with heart disease and appear to modulate cardiovascular-specific outcomes. Early detection of psychosocial factors through routine screening and gender-specific secondary prevention is encouraged. Trial registration number 12608000014358.
机译：目的探讨在多中心心脏病患者住院期间的一项重大急性心血管事件（MACE）的社会心理决定因素和医院间变异性，参加由护士领导的二级预防计划。方法回顾性分析602例随机分配至出院后标准护理（n = 296）或家庭干预（n = 306）的心脏病住院患者的病历，并长期随访个体化多学科支持。基线社会心理分析包括抑郁状态，与健康相关的生活质量（HRQoL），社会隔离和轻度认知障碍（MCI）。多变量分析检查了按性别分列的2年全因死亡率的MACE综合发生率与计划外的心血管相关住院的独立相关性。结果参加者年龄为70±10岁，男性431名（72％），冠心病377名（63％）。在2年的随访期间，有165名（27％）的参与者（114名男性，51名女性; p = 0.431）经历了MACE。男性MACE的独立相关因素是抑郁状态（OR 1.95，95％CI 1.06至3.58; p = 0.032），低体质HRQoL（OR 0.98，95％CI 0.96 to 1.00; p = 0.027）和合并症（OR 1.14） ，95％CI 1.04至1.25; p = 0.004）。在女性中，年龄（OR 1.06，95％CI 1.02至1.12; p = 0.008），MCI（OR 2.38，95％CI 1.09至5.18; p = 0.029）和医院部位预测为MACE（OR 2.32，95％CI 1.09）至4.93; p = 0.029）。结论患有心脏病的男性和女性的心理决定因素，认知障碍和对二级预防的反应是不同的，并且似乎可以调节心血管特异性结果。鼓励通过常规筛查和针对性别的二级预防及早发现社会心理因素。试用注册号12608000014358。

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