Musculoskeletal Comorbidities in Cardiac Patients: Prevalence, Predictors, and Health Services Utilization

作者：Marzolini Susan^*; Oh Paul I; Alter David; Stewart Donna E; Grace Sherry L

来源：Archives of Physical Medicine and Rehabilitation, 2012, 93(5): 856-862.

DOI：10.1016/j.apmr.2011.11.034

• Coronary artery diseases
• Rehabilitation

Marzolini S, Oh PI, Alter D, Stewart DE, Grace SL; on behalf of the Cardiac Rehab: Care Continuity through Automatic Referral Evaluation Investigators. Musculoskeletal comorbidities in cardiac patients: prevalence, predictors, and health services utilization. Arch Phys Med Rehabil 2012;93:856-62. %26lt;br%26gt;Objectives: To describe the prevalence of musculoskeletal conditions (MSKC) in patients with coronary artery disease (CAD); to examine the sociodemographic, clinical, and psychosocial predictors of these comorbidities; and to describe health care utilization by musculoskeletal comorbidity status. %26lt;br%26gt;Design: This was a cross-sectional, observational study in which patients were administered a questionnaire in the hospital and 1 year later. %26lt;br%26gt;Setting: Eleven hospitals in Ontario, Canada. %26lt;br%26gt;Participants: CAD patients (N=1803). %26lt;br%26gt;Interventions: Not applicable. %26lt;br%26gt;Main Outcome Measures: Sociodemographic, MSKC, clinical, and psychosocial factors were ascertained via questionnaire and in-hospital chart extraction. A health care utilization questionnaire was mailed 1 year later. %26lt;br%26gt;Results: Over half (56%) of the patients with CAD had MSKCs, with arthritis/joint pain accounting for 64.4% of these MSKCs. Patients who were older (odds ratio [OR]=1.03), women (OR=1.87), white (OR=1.80), with higher body mass index (OR=1.05), depressive symptoms (OR=1.92), and lower family income (OR=1.46) were more likely to present with MSKCs. One year posthospitalization, a greater proportion of those with MSKCs reported %26gt;= 1 cardiac-related emergency department visit (33.2% vs 28.3%, P=.03), hospital admission (30.7% vs 22%, P=.006), more primary care physician visits (6.6+/-5.6 vs 5.7+/-4.6. P%26lt;.001), and fewer cardiac rehabilitation referrals (61.5% vs 70%, P%26lt;.001). After adjusting for depressive symptoms, body mass index, age, income, ethnicity, and sex, MSKCs predicted only hospital readmissions. %26lt;br%26gt;Conclusions: Over half of the patients hospitalized for CAD have MSKCs. Those with MSKCs have a physical and psychosocial profile that places them at greater cardiovascular risk than those with CAD only, explaining, in part, their greater health care utilization. Despite a greater need for comprehensive risk factor management in patients with MSKCs, fewer were referred to cardiac rehabilitation.

• 出版日期2012-5
• 单位河北医科大学