Assessing the variance in anxiety, depression, lifestyle and readmission outcomes between patients treated for acute ST elevation myocardial infarction with Primary Percutaneous Intervention versus Thrombolysis
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AbstractAnxiety levels are known to be elevated following a Myocardial Infarction (MI). If untreated, results can lead to depression and an increase in recurrent events (Frasure-Smith, Lesperance, Talajic, 1994). Patients undergoing thrombolysis to treat their MI remain in hospital for approximately 5 days. The introduction of Primary Percutaneous Coronary Intervention (PPCI) has seen the Bristol Royal Infirmary (BRI) reduce PPCI patients' length of stay to an average of 2.7 days (Oriolo & Tagney, 2011). There is little evidence to indentify if this results in positive or negative effects on patient anxiety and depression. Length of in-patient stay affects patient's ability to absorb information (Astin et al 2008a). A short stay in hospital may affect anxiety due to less time spent on providing information and support to patients and their families. It is possible prolonged recovery or increased readmissions could be due to anxiety issues. The study aim is to investigate if anxiety and depression levels in PPCI patients from South Bristol result in different outcomes compared to Thrombolysis patients. A retrospective study of patients admitted to BRI with a first time STEMI treated with either Thrombolysis or PPCI from April 2004 to March 2010. The study will provide insight into patients' motivation to lifestyle changes. Overall, the study will identify improvement or deterioration in patient recovery from an MI with the introduction of PPCI. Myocardial Ischemia National Audit Project (MINAP) provided patient identification data. MINAP data was matched with the BRI Cardiac Rehabilitation Patient Audit tracking System (CRPATS). Hospital anxiety and depression scores (HADS) were used, to measure emotional outcomes. Readmission data was collected from PATS, hospital and patient medical records. Cardiac rehabilitation attendance and lifestyle outcomes were obtained from CRPATS data. Patient information remains anonymous for the purpose of this study. Application of the Statistical Package for the Social Sciences (SPSS) calculated statistical analysis. Unplanned re-admissions occurred sooner for PPCI patients at the BRI (p = .034) as did cardiac related re-admissions (p = .049). A significant link exists with PPCI increased number of cardiac related re-admissions and increased phase II 1 depression scores (P = .024). PPCI patients had shorter hospital admissions following their initial event (P = .005). PPCI deaths occurred earlier than Thrmobolysis (P = .001) Shorter hospital admissions were linked to increased phase II depression (P = .041), phase III anxiety scores (P = .031) anxiety levels (P = .009) in thrombolysis patients. PPCI patients anxiety improved at phase III compared with Thrombolysis (p = .031). Thrombolysis depression levels and scores demonstrate significant reductions between phases (P = .037). Female anxiety scores were higher than male at phase III (P = .019). Cholesterol and Smoking improved between phase II and III. Activity decreased in both treatments between phases. Longer admissions were linked to decreased diastolic blood pressure, weight and alcohol. Females have poorer outcomes in terms of risk factor management between phase II and III cardiac rehabilitation than males. The introduction of PPCI has not been detrimental to South Bristol patients outcomes. More prospective studies are necessary to identify if links with length of stay, readmission time and premature deaths are valid amongst PPCI patients. Further investigation is necessary to find reasons behind reduced activity and poorer outcomes for females at phase III.
PublisherUniversity of Chester
TypeThesis or dissertation
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