Latent profiles and transitions of acute psychological stress in patients with acute myocardial infarction after percutaneous coronary intervention and their association with cardiac rehabilitation participation.

AIM: To explore the dynamic transitions of latent profiles of acute psychological stress in patients with acute myocardial infarction across three time points and their association with cardiac rehabilitation participation, and to provide new insights for improving cardiac rehabilitation participation in patients with acute myocardial infarction.

DESIGN

This study was a prospective longitudinal cohort study.

METHODS

The convenience sampling method was used to select 262 patients with acute myocardial infarction as research subjects. Measurements were conducted three times using the Stanford Acute Stress Reaction Questionnaire and the cardiac rehabilitation scale: at T1 (after PCI when the patient's condition was stabilized), at T2 (1 month after PCI), and at T3 (3 months after PCI). Latent profile analysis (LPA) was used to identify heterogeneous subgroups of acute psychological stress at each time point. Latent Transition Analysis (LTA) was used to characterize the dynamic transition patterns over time. Furthermore, a multivariate Logistic regression model was applied to examine the association between different stress evolution trajectories and low cardiac rehabilitation participation.

RESULTS

A total of 248 valid questionnaires were collected. The prevalence of severe acute stress symptoms at T1, T2 and T3 was 58.87, 29.84 and 18.15%, respectively. At the three time points of acute psychological stress measurement, three latent profiles were identified: low psychological stress group (C1), moderate psychological stress group (C2) and high psychological stress group (C3). Latent transition analysis identified six main evolution types: 28.23% for C1 → C1 → C1, 18.55% for C2 → C2 → C2, 22.18% for C3 → C3 → C3, 14.52% for the remitting type (C3 → C2 → C1), 8.06% for the fluctuating type (C2 → C3 → C2) and 8.47% for the worsening type (C1 → C2 → C3). Compared with the persistently low-stress type, AMI patients with the persistently moderate-stress type (OR = 2.845, 95% CI: 1.542-5.248), persistently high-stress type (OR = 10.237, 95% CI: 5.128-20.415), remitting type (OR = 2.156, 95% CI: 1.298-3.582), fluctuating type (OR = 4.521, 95% CI: 2.567-7.965), and worsening type (OR = 6.834, 95% CI: 3.245-14.385) had significantly higher odds of low cardiac rehabilitation participation (all p < 0.05).

CONCLUSION

Acute psychological stress evolution trajectories are significantly associated with cardiac rehabilitation participation among patients with acute myocardial infarction. There are complex two-way transitions between stress latent profiles, and early clinical identification and continuous psychological intervention are associated with improved patients' cardiac rehabilitation participation levels.