Does a pre-existing musculoskeletal condition worsen outcomes in acute coronary syndrome?
Problem
Musculoskeletal conditions are a common reason for consulting primary care and a major cause of years lived with disability. Many people with painful musculoskeletal conditions have other long-term conditions necessitating hospitalisation. Musculoskeletal conditions may affect outcomes of other conditions managed within hospital through pain, restricted functioning and mobility, and sleep interference. These factors may hinder or delay delivery of appropriate treatment, thereby reducing its effectiveness, potentially extending time to discharge from hospital, and worsening outcomes of hospitalisation. The objective was to determine whether people with musculoskeletal pain spend longer in hospital and have worse short-term outcomes after hospitalisation with acute coronary syndrome (ACS).
Approach
We used information on patients aged 45 years and over newly diagnosed with ACS between 1998-2019 recorded within a large UK database of general practice records (Clinical Practice Research Datalink) linked to hospital data. We identified primary care consultations by these patients for musculoskeletal pain in the 24 months prior to ACS hospitalisation. Length of hospital stay and risk of worse hospital outcomes including mortality and readmission within 30 days of discharge were compared between those with pre-existing musculoskeletal pain and those without. We assessed whether findings varied by time since most recent musculoskeletal pain consultation (within 6 months vs 6-24 months before hospitalisation date) and severity (using prescription of strong opioid analgesics and referral as proxies for greater severity).
Findings
There were 33,870 patients with a new hospitalisation for ACS. Mean age was 70. 12,669 (37%) had consulted for a painful musculoskeletal condition in the previous 24 months. Patients with a musculoskeletal pain consultation had an increased risk of readmission for any cause to hospital within 30 days of discharge after adjustment for comorbidity and sociodemographic characteristics (21% vs 19% readmitted; adjusted odds ratio 1.08; 95% CI 1.02,1.14). Risk of readmission was increased further in those with a more recent consultation and severe musculoskeletal pain (23% readmitted). Length of hospital stay was longer in those with a more recent consultation and severe musculoskeletal pain (mean difference 0.8 days; adjusted incident rate ratio 1.06; 1.01, 1.11), as was risk of mortality within 30 days (although not statistically significant, adjusted odds ratio 1.17; 0.98, 1.39).
Consequences
Musculoskeletal pain is associated with poorer short-term outcomes from ACS. Given the high rate of musculoskeletal pain in patients with ACS, increased awareness of the impact of such pain may in particular reduce rates of readmission to hospital following ACS. Further work should assess whether musculoskeletal pain affects the long-term prognosis of cardiovascular conditions, impacts on service utilisation and costs after ACS, and whether there are potential interventions to ameliorate these effects at either a population level or during inpatient stays.