Trajectories and associated factors of life-space in older patients following percutaneous coronary intervention: a mixed-methods study.

چکیده اصلی

BACKGROUND: Older patients following percutaneous coronary intervention (PCI) face long-term health risks such as in-stent restenosis. Life-space serves as a valuable clinical indicator for assessing and predicting the overall health of patients. Monitoring changes in life-space can facilitate early detection of health status changes. This study aimed to identify the trajectories and associated factors of life-space among older patients following PCI, thereby prompting timely intervention and improving cardiac rehabilitation outcomes. METHODS: A total of 236 patients were enrolled. During hospitalization, patients' general information was assessed. At 1, 3, and 6 months after discharge, the patients' life-space was assessed firstly, followed by semi-structured interviews with voluntary participants via outpatient or telephone. Purposive sampling selected 10 patients from the low-to-medium trajectory groups for qualitative analysis based on information sufficiency. Latent class growth model was used to analyze life-space trajectories, and multinomial logistic regression analysis was conducted to examine their associated factors. Conventional content analysis method was used to provide additional possible factors hindering patients from achieving high-level life-space trajectory. RESULTS: The life-space of older patients following PCI showed an upward trend within 6 months of discharge, with an initial rapid increase followed by a slower progression. Three trajectory subgroups of life-space were identified: low-level persistently restricted group (18.14%), medium-level gradually improving group (47.55%), and high-level unrestricted group (34.31%). Factors associated with trajectory membership included times of PCI, single stent implantation, outings due to family affairs, exercise endurance, depression, and self-efficacy. Additionally, qualitative analysis revealed 4 categories of factors associated with achieving a high-level life-space: physical symptom fluctuation factors, psychosocial adaptation factors, information-cognitive coordination factors, and external environmental interaction factors. CONCLUSION: There were three distinct heterogeneous trajectories, including one with persistently restricted life-space. Factors associated with life-space trajectories include physiological, psychosocial, disease cognition, and environmental factors. Targeted interventions such as symptom management, psychological counseling, health education, and supportive external environment may promote life-space expansion.

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