Pascal B Meyre1,2, Anne Springer1,2, Stefanie Aeschbacher1,2, Steffen Blum1,2, Nicolas Rodondi3,4, Juerg H Beer5, Marcello Di Valentino6,7, Peter Ammann8, Manuel Blum3,4, Rebecca Mathys2, Christine Meyer-Zürn1,2, Leo H Bonati9, Christian Sticherling1,2, Matthias Schwenkglenks10, Michael Kühne1,2, David Conen2,11, Stefan Osswald1,2. 1. Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland. 2. Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland. 3. Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland. 4. Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 5. Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Zürich, Switzerland. 6. Department of Cardiology, Ospedale San Giovanni, Bellinzona, Switzerland. 7. Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland. 8. Division of Cardiology, St. Gallen, Switzerland. 9. Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland. 10. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland. 11. Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Abstract
BACKGROUND: A high burden of cardiovascular comorbidities puts patients with atrial fibrillation (AF) at high risk for hospitalizations, but the role of other factors is less clear. HYPOTHESIS: To determine the relationship between psychosocial factors and the risk of unplanned hospitalizations in AF patients. METHODS: Prospective observational cohort study of 2378 patients aged 65 or older with previously diagnosed AF across 14 centers in Switzerland. Marital status and education level were defined as social factors, depression and health perception were psychological components. The pre-defined outcome was unplanned all-cause hospitalization. RESULTS: During a median follow-up of 2.0 years, a total of 1713 hospitalizations occurred in 37% of patients. Compared to patients who were married, adjusted rate ratios (aRR) for all-cause hospitalizations were 1.28 (95% confidence interval [CI], 0.97-1.69) for singles, 1.31 (95%CI, 1.06-1.62) for divorced patients, and 1.02 (95%CI, 0.82-1.25) for widowed patients. The aRRs for all-cause hospitalizations across increasing quartiles of health perception were 1.0 (highest health perception), 1.15 (95%CI, 0.84-1.59), 1.25 (95%CI, 1.03-1.53), and 1.66 (95%CI, 1.34-2.07). No different hospitalization rates were observed in patients with a secondary or primary or less education as compared to patients with a college degree (aRR, 1.06; 95%CI, 0.91-1.23 and 1.05; 95%CI, 0.83-1.33, respectively). Presence of depression was not associated with higher hospitalization rates (aRR, 0.94; 95%CI, 0.68-1.29). CONCLUSIONS: The findings suggest that psychosocial factors, including marital status and health perception, are strongly associated with the occurrence of hospitalizations in AF patients. Targeted psychosocial support interventions may help to avoid unnecessary hospitalizations. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT02105844.
BACKGROUND: A high burden of cardiovascular comorbidities puts patients with atrial fibrillation (AF) at high risk for hospitalizations, but the role of other factors is less clear. HYPOTHESIS: To determine the relationship between psychosocial factors and the risk of unplanned hospitalizations in AF patients. METHODS: Prospective observational cohort study of 2378 patients aged 65 or older with previously diagnosed AF across 14 centers in Switzerland. Marital status and education level were defined as social factors, depression and health perception were psychological components. The pre-defined outcome was unplanned all-cause hospitalization. RESULTS: During a median follow-up of 2.0 years, a total of 1713 hospitalizations occurred in 37% of patients. Compared to patients who were married, adjusted rate ratios (aRR) for all-cause hospitalizations were 1.28 (95% confidence interval [CI], 0.97-1.69) for singles, 1.31 (95%CI, 1.06-1.62) for divorced patients, and 1.02 (95%CI, 0.82-1.25) for widowed patients. The aRRs for all-cause hospitalizations across increasing quartiles of health perception were 1.0 (highest health perception), 1.15 (95%CI, 0.84-1.59), 1.25 (95%CI, 1.03-1.53), and 1.66 (95%CI, 1.34-2.07). No different hospitalization rates were observed in patients with a secondary or primary or less education as compared to patients with a college degree (aRR, 1.06; 95%CI, 0.91-1.23 and 1.05; 95%CI, 0.83-1.33, respectively). Presence of depression was not associated with higher hospitalization rates (aRR, 0.94; 95%CI, 0.68-1.29). CONCLUSIONS: The findings suggest that psychosocial factors, including marital status and health perception, are strongly associated with the occurrence of hospitalizations in AF patients. Targeted psychosocial support interventions may help to avoid unnecessary hospitalizations. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT02105844.
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Authors: Pascal B Meyre; Anne Springer; Stefanie Aeschbacher; Steffen Blum; Nicolas Rodondi; Juerg H Beer; Marcello Di Valentino; Peter Ammann; Manuel Blum; Rebecca Mathys; Christine Meyer-Zürn; Leo H Bonati; Christian Sticherling; Matthias Schwenkglenks; Michael Kühne; David Conen; Stefan Osswald Journal: Clin Cardiol Date: 2020-11-10 Impact factor: 3.287
Authors: Pascal B Meyre; Anne Springer; Stefanie Aeschbacher; Steffen Blum; Nicolas Rodondi; Juerg H Beer; Marcello Di Valentino; Peter Ammann; Manuel Blum; Rebecca Mathys; Christine Meyer-Zürn; Leo H Bonati; Christian Sticherling; Matthias Schwenkglenks; Michael Kühne; David Conen; Stefan Osswald Journal: Clin Cardiol Date: 2020-11-10 Impact factor: 3.287