title: Multiple Chronic Conditions and Psychosocial Limitations in Patients Hospitalized with an Acute Coronary Syndrome.
abstract: As adults live longer, multiple chronic conditions have become more prevalent over the past several decades. We describe the prevalence of, and patient characteristics associated with, cardiac- and non-cardiac-related multimorbidities in patients discharged from the hospital after an acute coronary syndrome.
  
  
  
  We studied 2174 patients discharged from the hospital after an acute coronary syndrome at 6 medical centers in Massachusetts and Georgia between April 2011 and May 2013. Hospital medical records yielded clinical information including presence of eight cardiac-related and eight non-cardiac-related morbidities on admission. We assessed multiple psychosocial characteristics during the index hospitalization using standardized in-person instruments.
  
  
  
  The mean age of the study sample was 61 years, 67% were men, and 81% were non-Hispanic whites. The most common cardiac-related morbidities were hypertension, hyperlipidemia, and diabetes (76%, 69%, and 31%, respectively). Arthritis, chronic pulmonary disease, and depression (20%, 18%, and 13%, respectively) were the most common noncardiac morbidities. Patients with ≥4 morbidities (37% of the population) were slightly older and more frequently female than those with 0-1 morbidity; they were also heavier and more likely to be cognitively impaired (26% vs 12%), have symptoms of moderate/severe depression (31% vs 15%), high perceived stress (48% vs 32%), a limited social network (22% vs 15%), low health literacy (42% vs 31%), and low health numeracy (54% vs 42%).
  
  
  
  Multimorbidity, highly prevalent in patients hospitalized with an acute coronary syndrome, is strongly associated with indices of psychosocial deprivation. This emphasizes the challenge of caring for these patients, which extends well beyond acute coronary syndrome management.
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Mayra
authors.initials: M
authors.lastname: Tisminetzky
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Jerry
authors.initials: J
authors.lastname: Gurwitz
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester.
authors.forename: Jane S
authors.initials: JS
authors.lastname: Saczynski
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Erskine
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Molly E
authors.initials: ME
authors.lastname: Waring
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Milena
authors.initials: M
authors.lastname: Anatchkova
authors.affiliation: Department of Community Medicine, Mercer University School of Medicine, Macon, Ga.
authors.forename: Hamza
authors.initials: H
authors.lastname: Awad
authors.affiliation: Department of Community Medicine, Mercer University School of Medicine, Macon, Ga.
authors.forename: David C
authors.initials: DC
authors.lastname: Parish
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Catarina
authors.initials: C
authors.lastname: Kiefe
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester; Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester. Electronic address: Robert.Goldberg@umassmed.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Goldberg
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000523:psychology*; D016009:Chi-Square Distribution; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D000071069:Multiple Chronic Conditions / Q000453:epidemiology / Q000523:psychology*; D015995:Prevalence; D011446:Prospective Studies; D011610:Psychosocial Deprivation
keywords: Acute coronary syndrome; Multimorbidities