Sex, age, and cohabitation status: is it associated with perceived need of follow-up after percutaneous coronary intervention?
Authors: Hjertvikrem N , Instenes I , Borregaard B , Brors G , Falun N , Helmark C , Palm P , Pettersen T R , Rotevatn S , MacNeil Vroomen J L , Zwisler A D , Norekval T M 
Published: October 2022

Abstract

Background
Health status, and clinical- and sociodemographic factors influence the type of follow-up care for patients after percutaneous coronary intervention (PCI). However, patients' perceived need for follow-up and how this is associated with health status, sociodemographic and clinical variables in countries with different follow-up after PCI is scarcely examined. Norway and Denmark have similar healthcare systems, yet, only Danish patients are routinely referred to cardiac rehabilitation (CR).

Aim
To determine how patients' perceived need for follow-up is associated with health status, and clinical and sociodemographic factors in two Nordic countries with different CR referral practices.

Methods
Real-world data from 3417 patients at seven Norwegian and Danish university hospitals were collected in the prospective multicentre CONCARDPCI study. Patients' perceived need for follow-up were obtained two months post-discharge (index event). Sociodemographic characteristics were obtained by self-report during the index hospitalization. Clinical data were collected from patients' medical records and the Norwegian Registry on Invasive Cardiology. Mental and physical health were measured using the disease-specific Myocardial Infarction Dimensional Assessment Scale (MIDAS) and the generic RAND-12 questionnaire. We used t-tests and chi-square tests to test the differences between patients that want and do not want follow-up. Logistic regression further scrutinized the aims, reported as odds ratios (ORs) with 95% confidence intervals (CIs).

Results
Most patients were men (78%) with a mean age of 66 years (SD 11). Those not wanting follow-up were older (mean 4.8 years, p&lt;0.001), more often men (82% vs 78%, p=0.043), had lower education level (primary school 33% vs 16%, p&lt;0.001), and had more often three or more comorbidities (54% vs 43%, p=0.003). They reported, however, to be healthier on both mental component scores (MIDAS emotional 16.4 vs 25.1, p&lt;0.001, RAND-12 Mental 53.3 vs 48.4, p&lt;0.001) and physical component scores (MIDAS Physical 19.8 vs 27.9, p&lt;0.001, RAND-12 Physical 50.3 vs. 46.6, p&lt;0.001). Stratified by country, for Norwegian patients, not wanting follow-up was almost twice as likely if living alone (OR 1.93, CI 1.22; 3.06), half as likely if being a woman (OR 0.48, CI 0.26; 0.85), increasingly likely with age (OR 1.06, CI 1.04; 1.08] and decreasingly likely with educational level (e.g. university &gt;4 years: OR 0.30, CI 0.16; 0.55). In contrast, age, sex and cohabitation status was not significantly associated with perceived need of follow-up for Danish patients.

Conclusions
Our findings suggest that sociodemographic factors are more important for patients' perceived need for follow-up than both health status and patient clinical characteristics. Country differences further suggest that there is not an easy way to classify patients' needs, and a one-size-fits-all follow-up programme may not exist in either CR pathways.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): The Western Norway Health Authority,The Norwegian Nurses Association