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

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    Author
    Kure, CE; Chan, Y-K; Ski, CF; Thompson, DR; Carrington, MJ; Stewart, S
    Date
    2016-05-01
    Source Title
    Open Heart
    Publisher
    BMJ PUBLISHING GROUP
    University of Melbourne Author/s
    Ski, Chantal; Thompson, David
    Affiliation
    Psychiatry
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Kure, C. E., Chan, Y. -K., Ski, C. F., Thompson, D. R., Carrington, M. J. & Stewart, S. (2016). Gender-specific secondary prevention? Differential psychosocial risk factors for major cardiovascular events. OPEN HEART, 3 (1), https://doi.org/10.1136/openhrt-2015-000356.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/257979
    DOI
    10.1136/openhrt-2015-000356
    Abstract
    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.

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