Patient Engagement Following Acute Myocardial Infarction and Its Influence on Outcomes

The Patient Activation Measure (PAM) is a validated assessment tool that evaluates how engaged patients are in their own health care. The more engaged or “activated” patients are, the higher the score and the more likely they are to adhere to medical therapy and make healthy lifestyle choices. Little is known regarding patient activation in patients after an acute myocardial infarction. From March 2016 to December 2016, we administered PAM surveys to patients after myocardial infarction at the time of a clinic visit scheduled within 10 days of hospital discharge. Demographic and outcome data were collected. The primary outcome was defined as a composite end point of major medication errors, emergency department visits, and/or unplanned readmission. The secondary outcome was continued tobacco use after discharge. A total of 93 patients were enrolled and 39 (42%) were positive for the primary outcome. PAM scores ranged from 40.9 to 100 (median 62.6, interquartile range 56.0 to 72.1). In multivariable analysis, adjusting for age, gender, and burden of co-morbidities, patients with lower PAM scores were more likely to have the primary outcome (odds ratio 1.063, 95% confidence interval 1.020 to 1.109, p = 0.0041). Patients with lower PAM scores also were more likely to continue to use tobacco after discharge (odds ratio 1.060, 95% confidence interval 1.005 to 1.118, p = 0.0325). In conclusion, we found an association between lower PAM scores and subsequent adverse clinical outcomes, including unplanned readmissions. Further investigation into the potential effect of education and coaching interventions in patients with low PAM scores after acute myocardial infarction is warranted.