MELBOURNE, AUSTRALIA — Differences in psychosocial factors in women vs men, for example depression and social isolation, may have influenced responses to a nurse-led home-based intervention aimed at preventing further cardiovascular events after hospitalization for heart disease, in a study published April 12, 2016 in OpenHeart[1].
The authors, led by Dr Christina E Kure (Australian Catholic University, Melbourne), found that older age and mild cognitive impairment independently predicted major adverse cardiac events (MACE) in women. Diminished physical capability, more comorbidity, and depressive symptoms were independently tied to MACE in men.
"Beyond pertinent pharmacological agents and devices," coauthor Dr Yih-Kai Chan (Australian Catholic University) told heartwire from Medscape in an email, "our data suggest that early intervention with integrated treatments to target depression and physical capability and fitness in men and cognitive impairment in women might be beneficial to prevent or reduce adverse cardiac health outcomes in the longer term."
The results point to the need for routine screening with short psychosocial risk-assessment tools, according to Chan. He emphasized secondary-prevention strategies that are personalized and gender-specific, along with coordinating treatment between cardiac- and mental-health providers.
"Optimal CAD disease management programs are important and should have the capability to apply flexible, guideline-based management, coordinate care, and provide individualized support," he said.
"We advocate for more innovative approaches to better manage those with complex clinical disorders to reduce excess healthcare utilization and improve patient quality of life."
Earlier analyses[2] based on the nurse-led home-based intervention suggested that the home-based intervention significantly decreased CV hospitalizations in men but made no difference in women, compared with standard care. The current study reevaluated data from the program to see whether those differences could have been due to gender-specific psychosocial factors.
The researchers retrospectively evaluated 602 inpatients (72% men, 63% with CAD) seen at two hospitals Australia (Hospital A and Hospital B) in Brisbane. Participants were randomized to standard care (n=296) or a nurse-led home-based intervention (n=306) aimed at preventing further MACE. Participants self-reported depressive symptoms. Researchers estimated social isolation based on whether the person lived alone or with others.
Over 2 years, more women than men in the home-based intervention experienced MACE (35% vs 24%, P=0.034). No significant difference was seen for standard care (24% vs 29%, P=0.313).
Independent MACE predictors in women included older age (OR 1.06, 95% CI 1.02–1.12; P=0.008), mild cognitive impairment (OR 2.38, 95% CI 1.09–5.18; P=0.029), and hospital site (OR 2.32, 95% CI 1.09–4.93; P=0.029). Thirty-eight percent of women at Hospital B experienced a MACE compared with 19% at Hospital A (P=0.006).
Outcomes differences between Hospital A and B could be related to unmeasured factors like personality, beliefs, and attitudes, the authors mentioned; unequal caseloads could also have contributed, because patient numbers were higher at Hospital B.
Independent predictors of MACE in men included depressive symptoms (OR 1.95, 95% CI 1.06–3.58; P=0.032), low physical capabilities (OR 0.98, 95% CI 0.96–1.00; P=0.027), and higher levels of comorbidity (OR 1.14, 95% CI 1.04–1.25; P=0.004).
Women were significantly older than men (73 vs 63 years, P<0.0001) and more likely to report depressive symptoms (P=0.020), have lower physical capabilities (P<0.0001), and live alone (P<0.0001).
The differences in outcomes for women and men could have been due to a number of factors, according to Chan. "Because CAD usually develops later in women than in men, it is possible that a combination of factors including old age, living alone, and cognitive impairment in women might have limited their ability to understand and follow medical treatments, compared with [relatively] younger men with CAD."
Also, he proposed, women may tend to pay more attention to and report their symptoms than men. Gender differences in patient-nurse interaction could also play a role.
The study was funded by Bupa Health Foundation. The authors report no relevant financial relationships.
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Heartwire from Medscape © 2016 Medscape, LLC
Cite this: Loneliness, Depression Hinder Success of Home-Based MI Secondary-Prevention Program - Medscape - May 03, 2016.
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