title: Acute stress disorder symptoms after evaluation for acute coronary syndrome predict 30-day readmission.
abstract: BACKGROUND
  Thirty-day readmissions are a major concern for hospitals. Even though numerous readmission risk prediction models have been developed, their performance has been modest, and few predictors are modifiable. Stress is a modifiable factor that may increase risk of adverse post-hospitalization outcomes. We examined whether posttraumatic stress days after evaluation for acute coronary syndrome (ACS)-termed acute stress disorder (ASD) symptoms-was associated with 30-day all-cause emergency department (ED) and hospital readmission.
  
  
  METHODS
  Participants were enrolled in the REactions to Acute Care and Hospitalization (REACH) study during ED evaluation for ACS. During inpatient stay or by phone after discharge, participants reported ASD symptoms in response to the event that brought them to the ED. ED or hospital readmissions within 30days of discharge were determined by research nurse record review. Logistic regression was used to assess the association between ASD symptoms and 30-day ED/hospital readmission.
  
  
  RESULTS
  In the analytic sample of 974 individuals, there were 123 ED/hospital readmissions within 30days of discharge. A 10-point ASD symptom increase was significantly associated with increased 30-day readmission risk in an unadjusted model [odds ratio (OR)=1.32, p=0.001] and a model adjusted for demographics, clinical characteristics, and ACS discharge diagnosis (OR=1.24, p=0.03).
  
  
  CONCLUSIONS
  Posttraumatic stress shortly after acute coronary syndrome evaluation may help to understand vulnerability for readmission.
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States. Electronic address: js4456@cumc.columbia.edu.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Sumner
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Kronish
authors.affiliation: Department of Emergency Medicine, Columbia University Medical Center, New York, NY, United States.
authors.forename: Bernard P
authors.initials: BP
authors.lastname: Chang
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, United States.
authors.forename: Ying
authors.initials: Y
authors.lastname: Wei
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schwartz
authors.affiliation: Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States.
authors.forename: Donald
authors.initials: D
authors.lastname: Edmondson
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends*; D040701:Stress Disorders, Traumatic, Acute / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D013997:Time Factors
keywords: Acute coronary syndrome; Acute stress disorder; Posttraumatic stress; Readmission