Key result
Depressive status independently predicted a 2-year major acute cardiovascular event in men (OR 1.95), whereas mild cognitive impairment was a significant predictor in women (OR 2.38).
Why the study?
Psychosocial determinants and interhospital variability influencing major acute cardiovascular events during secondary prevention in heart disease patients were not well understood, particularly by gender.
Cohort (n=602)
Blinded adjudication of hospitalisations
1:1
Yes
Odds Ratio: 1.95 (95% CI 1.06–3.58)
p-value: p=0.032
Psychosocial determinants of major cardiovascular events differ by gender, with depression predicting MACE in men and mild cognitive impairment predicting MACE in women, highlighting the need for gender-specific secondary prevention.
Gender-specific psychosocial predictors of MACE may guide risk stratification; leaves open whether sex-tailored interventions improve outcomes in prospective trials.
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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Kure et al. (2016) conducted a cohort in Chronic heart disease (n=602). Depressive status (in men) vs. Absence of depressive status was evaluated on Major acute cardiovascular event (MACE) at 2 years (OR 1.95, 95% CI 1.06 to 3.58, p=0.032). Depressive status independently predicted a 2-year major acute cardiovascular event in men (OR 1.95), whereas mild cognitive impairment was a significant predictor in women (OR 2.38).
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