title: A prospective cohort study investigating readmission, symptom attribution and psychological health within six months of primary percutaneous coronary intervention.
abstract: OBJECTIVE
  Following primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction, some patients are readmitted with potential ischaemic heart disease symptoms. This study investigated the proportion of PPCI patients readmitted due to potential ischaemic heart disease symptoms within six months, and the cause of symptoms and associated factors.
  
  
  RESULTS
  A prospective cohort study included consecutive PPCI patients. Baseline variables incorporated the Global Registry of Acute Coronary Events, the Charlson Comorbidity Index and self-report measures ENRICHD Social Support Inventory, Seattle Angina Questionnaire (SAQ) and Hospital and Anxiety and Depression Scale (HADS). At six months, repeat SAQ, HADS and readmission data were collected. Of 202 PPCI patients (mean 59.7 years (SD 13.9), 75.7% male), 38 (18.8%; 95% confidence interval 14.0-24.8%) were readmitted due to potential ischaemic heart disease symptoms (16 cardiac events, 22 indeterminate diagnosis) at six months. Mean HADS anxiety scores were higher for the readmission compared with the non-readmission group (baseline 9.5 vs. 7.1, p=0.006; six months 9.4 vs. 6.0, p<0.001). Angina symptoms were stable and infrequent throughout for both groups. Logistic regression modelling, including predictors HADS anxiety, SAQ angina stability, SAQ angina frequency, the Global Registry of Acute Coronary Events and the Charlson Comorbidity Index, determined HADS anxiety as a predictor of readmission with adjusted odds ratio of 1.12 (95% confidence interval 1.03-1.22, p=0.008).
  
  
  CONCLUSIONS
  One in six patients were readmitted due to potential ischaemic heart disease symptoms, with the largest proportion receiving an indeterminate readmission diagnosis. Elevated levels of anxiety at baseline were predictive of readmission with potential ischaemic heart disease symptoms at six months.
authors.affiliation: Central Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, UK heather@iles-smith.co.uk.
authors.forename: Heather
authors.initials: H
authors.lastname: Iles-Smith
authors.affiliation: Central Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: McGowan
authors.affiliation: Central Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, UK.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Campbell
authors.affiliation: Central Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, UK.
authors.forename: Cat
authors.initials: C
authors.lastname: Mercer
authors.affiliation: Central Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, UK.
authors.forename: Christi
authors.initials: C
authors.lastname: Deaton
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D016017:Odds Ratio; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012737:Sex Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
keywords: Myocardial infarction; anxiety; chest pain; primary percutaneous coronary intervention; psychological health; readmission; symptom attribution