Effects of a multidisciplinary transitional care programme on self-management and quality of life in patients undergoing percutaneous coronary intervention: a propensity score-matched analysis.

Abstract

Adequate self-management support following percutaneous coronary intervention (PCI) remains a recognised challenge. This study evaluated the Integrated Psychocardiology Transitional Care (IPTC) programme's effect on self-management and quality of life, and the mechanism of their interaction. Retrospective cohort study. Outcomes were analysed for 697 patients after propensity score matching from an initial PCI registry cohort of 1148. The primary outcome was change in Coronary Artery Disease Self-Management Scale Score over 12 months. Secondary outcomes included the Seattle Angina Questionnaire (SAQ), 36-Item Short Form Health Survey (SF-36), Generalised Anxiety Disorder 7 and Patient Health Questionnaire 9 scores. Mixed-effects models and time-lagged mediation analysis were used to examine longitudinal changes and the mediating role of self-management. No between-group difference in self-management was observed at 1 month. Significant differences in self-management emerged at 3 months, 6 months and 12 months (all p<0.001). The mixed-effects model for repeated measures analysis revealed significant group × time interaction effects (F=183.1, p<0.001), indicating differential improvement trajectories favouring the IPTC group. The IPTC group showed significantly better SF-36 physical (45.6±9.6 vs 39.8±8.4, 95% CI 4.5 to 7.2, p<0.001) and mental (44.9±8.3 vs 41.7±8.1, 95% CI 2.0 to 4.4, p<0.001) scores at 12 months. Time-lagged mediation analysis confirmed self-management improvement mediated quality of life effects. The IPTC programme is associated with improved quality of life in PCI patients, and this association appears to be partly explained by enhanced self-management. These findings suggest that integrating psychology-informed transitional care into post-PCI care may be beneficial.