Social factors of health-related quality of life in older adults: a multivariable analysis.

PURPOSE: The objective of the analysis was to examine the relationships between sociodemographic, socioeconomic, psychosocial, and behavioural factors and both physical and mental health-related quality of life (HRQOL) in older adults. METHODS: The analysis was based on recent cross-sectional data of 1687 community residents from a whole population postal survey of German adults aged 65 years and older (33% response rate, 52% female, mean age 76 years). HRQOL was assessed using the 36-Item Short Form Survey (SF-36v2). For a differentiated analysis, hierarchical multiple linear regressions were performed. RESULTS: An internal health locus of control, physical activity, social support, and income were positively associated with physical HRQOL (Adj. R2 = 0.34; p < 0.001) and mental HRQOL (Adj. R2 = 0.18; p < 0.001), whereas an external health locus of control and age were negatively associated with both. Alcohol use and educational level were positively associated only with physical HRQOL, whilst female gender was negatively associated only with mental HRQOL. CONCLUSION: Sociodemographic, socioeconomic, psychosocial, and behavioural factors were associated with physical and mental HRQOL. These results highlight the importance of social factors in HRQOL and provide approaches for policy and practice to develop and implement tailored health interventions for older adults. Our findings may be transferable to municipalities in metropolitan areas of high-income European countries. CLINICAL TRIAL REGISTRATION: Not applicable.

Mental health indicators and their lifestyle associations in German students: a gender-specific multivariable analysis.

BACKGROUND: Statistics show that the number of received psychosocial counselling sessions remains at a constantly high level or has even increased since the COVID-19 pandemic situation in 2020. The objective of this work is to identify factors associated with students' mental health to improve prevention and promotion in mental health at universities. METHODS: The analyses were based on a cross-sectional data set collected by an online survey among 1,842 students from a German University of Applied Sciences in 2014. Descriptive statistics as well as nine different multiple linear regression models were calculated with IBM® SPSS® Statistics software. Mental health indicators used were mental health-related quality of life (mental HRQOL), depression, and anxiety, which were analysed in a gender-specific manner. RESULTS: The analyses showed that the mean of the mental HRQOL score of the SF-36 for the student sample (46.68) was lower than the values for German (48.76) or American (51.34) norm samples. A key finding was the differences in mental health indicators between male and female students. Women reported worse mental health status in comparison to men. Female gender (ß of -.09; p < 0.01), age (ß of -1.05; p < 0.01), underweight (ß of -.09; p < 0.05), smoking (ß of -.10; p < 0.05) and drug consumption (ß of -.15; p < 0.001) were negatively associated with mental health indicators. In our sample, a moderate consumption of alcohol within the female population (ß of .12; p < 0.01) and physical activity within the male sample (ß of .09; p < 0.05) were positively associated with mental health indicators. CONCLUSION: The gender-specific differences of students' mental health and its associations could be an important result for counselling services at universities to adjust methods according to gender. Contrary to the general societal perception, students have lower mental health than a norm sample even before the pandemic. Due to the additional mental stress caused by the pandemic, it can be assumed that mental health problems have increased even more. Universities should therefore pay more attention to the mental health of their students.

Social Factors of Dietary Risk Behavior in Older German Adults: Results of a Multivariable Analysis.

With this analysis, we aimed to examine the associations between social factors and dietary risk behavior in older adults. Data were collected through a full-population postal survey of German adults aged 65 years or older (n = 1687, 33% response proportion, 52% female, mean age = 76 years). Using principal component analysis (PCA), a data-driven Dietary Risk Behavior Index (DRB) was computed. Dietary risk behavior was defined as consumption frequencies of vegetables/fruit, whole grains, and dairy products below national dietary recommendations. By performing a multiple linear regression, we analyzed associations between sociodemographic, socioeconomic, psychosocial, and behavioral factors and dietary risk behavior. Physical activity, female gender, socioeconomic status, social support, and age (in the male sample) were negatively associated with dietary risk behavior. Alcohol consumption and smoking were positively associated with dietary risk behavior. A group-specific analysis revealed a higher goodness-of-fit for the low socioeconomic status group, older adults aged 65-79 years, and women. A comprehensive understanding of the relationships between social factors and dietary risk behavior in older adults assists the group-specific targeting of dietary-related interventions. Demand-oriented dietary interventions should account for underlying social conditions to reduce inequity in dietary risk behavior among older adults. The results of this work may be transferable to municipalities in high-income European countries.

The Effect of Cognitive Load on Auditory Susceptibility During Automated Driving.

OBJECTIVE: We experimentally test the effect of cognitive load on auditory susceptibility during automated driving. BACKGROUND: In automated vehicles, auditory alerts are frequently used to request human intervention. To ensure safe operation, human drivers need to be susceptible to auditory information. Previous work found reduced susceptibility during manual driving and in a lesser amount during automated driving. However, in practice, drivers also perform nondriving tasks during automated driving, of which the associated cognitive load may further reduce susceptibility to auditory information. We therefore study the effect of cognitive load during automated driving on auditory susceptibility. METHOD: Twenty-four participants were driven in a simulated automated car. Concurrently, they performed a task with two levels of cognitive load: repeat a noun or generate a verb that expresses the use of this noun. Every noun was followed by a probe stimulus to elicit a neurophysiological response: the frontal P3 (fP3), which is a known indicator for the level of auditory susceptibility. RESULTS: The fP3 was significantly lower during automated driving with cognitive load compared with without. The difficulty level of the cognitive task (repeat or generate) showed no effect. CONCLUSION: Engaging in other tasks during automated driving decreases auditory susceptibility as indicated by a reduced fP3. APPLICATION: Nondriving task can create additional cognitive load. Our study shows that performing such tasks during automated driving reduces the susceptibility for auditory alerts. This can inform designers of semi-automated vehicles (SAE levels 3 and 4), where human intervention might be needed.

Action Sounds Informing Own Body Perception Influence Gender Identity and Social Cognition.

Sensory information can temporarily affect mental body representations. For example, in Virtual Reality (VR), visually swapping into a body with another sex can temporarily alter perceived gender identity. Outside of VR, real-time auditory changes to walkers' footstep sounds can affect perceived body weight and masculinity/femininity. Here, we investigate whether altered footstep sounds also impact gender identity and relation to gender groups. In two experiments, cisgender participants (26 females, 26 males) walked with headphones which played altered versions of their own footstep sounds that sounded more typically male or female. Baseline and post-intervention measures quantified gender identity [Implicit Association Test (IAT)], relation to gender groups [Inclusion of the Other-in-the-Self (IOS)], and perceived masculinity/femininity. Results show that females felt more feminine and closer to the group of women (IOS) directly after walking with feminine sounding footsteps. Similarly, males felt more feminine after walking with feminine sounding footsteps and associated themselves relatively stronger with "female" (IAT). The findings suggest that gender identity is temporarily malleable through auditory-induced own body illusions. Furthermore, they provide evidence for a connection between body perception and an abstract representation of the Self, supporting the theory that bodily illusions affect social cognition through changes in the self-concept.

Ozone exposure and health effects: a protocol for an umbrella review and effect-specific systematic maps.

INTRODUCTION: Ambient ozone exposure may be adverse to health. Since the reported associations between ozone and health effects are heterogeneous and the underlying pathways are indistinct, the overall relationship remains unclear. Only a few overall syntheses of the evidence regarding ozone and health effects are available to date. METHODS AND ANALYSIS: We plan to summarise the current evidence on ozone-related health effects systematically. First, to identify the possible associations between ambient ozone exposure and health outcomes, we will conduct an umbrella review. PubMed, Web of Science and grey literature will be searched for systematic reviews on exposure to ambient ozone and any possible health endpoints published before 31 May 2019. Data selection and extraction will be carried out by one reviewer, and a second reviewer will check the agreement of a sample of the studies. The methodological quality of the eligible systematic reviews and level of evidence regarding ozone and every specific health effect will be evaluated. Second, for each of the identified effects with a high level of evidence, comprehensive information retrievals will be conducted, considering both epidemiological and experimental studies. The study selection and data mapping will be carried out by one reviewer and checked by the second reviewer. We will summarise the information of the filtered epidemiological and experimental studies to conduct several systematic maps presenting the currently available evidence for the specific health effect. Because the association between ozone exposure and chronic obstructive pulmonary disease (COPD) is relatively well investigated, we will at least conduct one systematic map of ozone and COPD. ETHICS AND DISSEMINATION: No ethical approval is required for this study. The completed umbrella review and systematic maps will be considered for publication and presentation. We will additionally upload the relevant data to publicly accessible online databases. PROSPERO REGISTRATION NUMBER: CRD42019123064.

Depression and anxiety with exposure to ozone and particulate matter: An epidemiological claims data analysis.

BACKGROUND: Depression and anxiety have complex etiologies and are associated with a significant burden of disease. Although air pollution has been hypothesized as a possible risk factor of these disorders, the associations are still under-investigated. We aimed to analyze associations between long-term exposure to ambient ozone and particulate matter with diameter <10 µm (PM10) and diagnoses of depression and anxiety in a general population. METHODS: We utilized data from a large statutory health insurance company from Saxony, Germany. Information on outpatient clinical diagnoses of depression and anxiety was available for the years 2005-2014. We assigned ambient ozone and PM10 estimates to residential districts of 1.13 million individuals aged 16 and older. Depression and anxiety were defined as diagnoses counts. Associations with depression and anxiety were assessed using adjusted generalized estimating equations models. RESULTS: In the ten-year study period, the observed prevalences of depression and anxiety were 7.40% and 3.82%, respectively. In the two-pollutant model, 10 more days with a maximum 8-h average ozone concentration exceeding 120 µg/m³ resulted in a relative risk (RR) of 1.010 with 95% confidence interval (CI) (1.005, 1.014) for depression and an RR of 1.007 (95% CI (1.000, 1.014)) for anxiety. The effect estimates of PM10 for depression and anxiety were 1.180 (95% CI (1.160, 1.201)) and 1.176 (95% CI (1.148, 1.205)) per 10 µg/m³ increase in PM10 concentration, respectively. Age, sex, and access to healthcare of the individual were also associated with the diagnosis of the disorders. The associations were consistent across one- and two-pollutant models. CONCLUSIONS: Our findings indicate that increased levels of ambient ozone and PM10 may elevate the risk of a depression or anxiety diagnosis in the general population. However, given the lack of data on individual air pollutant exposure and socioeconomic status, our results should be interpreted with caution. Further well-designed epidemiological studies should replicate our findings.

The influence of cognitive load on susceptibility to audio.

In this study we evaluate how cognitive load affects susceptibility to auditory signals. Previous research has used the frontal P3 (fP3) event related potential response to auditory novel stimuli as an index for susceptibility to auditory signals. This work demonstrated that tasks that induce cognitive load such as visual and manual tasks, reduced susceptibility. It is however unknown whether cognitive load without visual or manual components also reduces susceptibility. To investigate this, we induced cognitive load by means of the verb generation task, in which participants need to think about a verb that matches a noun. The susceptibility to auditory signals was measured by recording the event related potential in response to a successively presented oddball probe stimulus at 3 different inter-stimulus intervals, 0 ms, 200 ms or 400 ms after the offset of the noun from the verb generation task. An additional control baseline condition, in which oddball response was probed without a verb generation task, was also included. Results show that the cognitive load associated with the verb task reduces fP3 response (and associated auditory signal susceptibility) compared to baseline, independent of presentation interval. This suggests that not only visual and motor processing, but also cognitive load without visual or manual components, can reduce susceptibility to auditory signals and alerts.

The influence of rewards on (sub-)optimal interleaving.

We investigate how the rewards of individual tasks dictate a priori how easy it is to interleave two discrete tasks efficiently, and whether people then interleave efficiently. Previous research found that people vary in their ability to interleave efficiently. Less attention has been given to whether it was realistic to expect efficient interleaving, given the reward rate of each of the involved tasks. Using a simulation model, we demonstrate how the rewards of individual tasks lead to different dual-task interleaving scenarios. We identify three unique dual-task scenarios. In easy scenarios, many strategies for time division between tasks can achieve optimal performance. This gives great opportunity to optimize performance, but also leads to variation in the applied strategies due to a lack of pressure to settle on a small set of optimal strategies. In difficult scenarios, the optimal strategy is hard to identify, therefore giving little opportunity to optimize. Finally, constrained scenarios have a well-defined prediction of the optimal strategy. It gives a narrow prediction, which limits the options to achieve optimal scores, yet given the structure people are able to optimize their strategies. These scenarios are therefore best to test people's general capability of optimizing interleaving. We report three empirical studies that test these hypotheses. In each study, participants interleave between two identical discrete tasks, that differ only in the underlying reward functions and the combined result (easy, difficult, or constrained scenario). Empirical results match the theoretical pattern as predicted by simulation models. Implications for theory and practice are discussed.

Susceptibility to audio signals during autonomous driving.

We investigate how susceptible human drivers are to auditory signals in three situations: when stationary, when driving, or when being driven by an autonomous vehicle. Previous research has shown that human susceptibility is reduced when driving compared to when being stationary. However, it is not known how susceptible humans are under autonomous driving conditions. At the same time, good susceptibility is crucial under autonomous driving conditions, as such systems might use auditory signals to communicate a transition of control from the automated vehicle to the human driver. We measured susceptibility using a three-stimulus auditory oddball paradigm while participants experienced three driving conditions: stationary, autonomous, or driving. We studied susceptibility through the frontal P3 (fP3) Electroencephalography Event-Related Potential response (EEG ERP response). Results show that the fP3 component is reduced in autonomous compared to stationary conditions, but not as strongly as when participants drove themselves. In addition, the fP3 component is further reduced when the oddball task does not require a response (i.e., in a passive condition, versus active). The implication is that, even in a relatively simple autonomous driving scenario, people's susceptibility of auditory signals is not as high as would be beneficial for responding to auditory stimuli.

Coronary Angiography and Revascularization Following Coronary Artery Bypass Grafting in British Columbia: Incidence, Predictors and Longer-term Outcomes.

BACKGROUND: Coronary artery bypass grafting (CABG) is established treatment for subsets of coronary artery disease (CAD). Observational data have characterised significant progression of native coronary as well as graft vessel disease during longer-term follow-up, potentially reducing the benefit of CABG. We sought to assess longer-term outcomes following CABG by determining rates of repeat coronary angiography, revascularization procedures, and survival. METHODS: Data for all patients undergoing isolated CABG in British Columbia between 2001 and 2009 inclusive, and with follow-up until the end of 2013, were retrieved from the British Columbia Cardiac Registry. Cox proportional hazard regression and competing risk regression were performed for survival and subsequent cardiac procedures (coronary angiography, percutaneous coronary intervention [PCI] or repeat CABG). RESULTS: Data were available from 17,316 patients with a mean age at index CABG of 65.7 ± 9.8 years. At a median follow-up of 8.5 (range 4.0 to 12.9) years, 3185 patients (18.4%) had died, 3135 (18.1%) underwent repeat coronary angiography with or without PCI or repeat CABG, and 11,557 (66.7%) had survived without additional procedures. Of those who underwent angiography, 1459 patients (46.5%) underwent further revascularization. In multivariate analysis, the strongest predictors of long-term mortality were dialysis dependency and age >75, whereas left internal mammary artery utilization and aspirin therapy were protective. Repeat revascularization predicted survival (adjusted hazard ratio 0.76; 95% confidence interval, 0.63-0.92; P = 0.004), whereas angiography alone did not. CONCLUSIONS: Following CABG, patients frequently undergo repeat coronary angiography. Although only a minority of patients receive further revascularization, this appears to be associated with longer-term survival.

In Vivo Molecular Characterization of Abdominal Aortic Aneurysms Using Fibrin-Specific Magnetic Resonance Imaging.

BACKGROUND: The incidence of abdominal aortic aneurysms (AAAs) will significantly increase during the next decade. Novel biomarkers, besides diameter, are needed for a better characterization of aneurysms and the estimation of the risk of rupture. Fibrin is a key protein in the formation of focal hematoma associated with the dissection of the aortic wall and the development of larger thrombi during the progression of AAAs. This study evaluated the potential of a fibrin-specific magnetic resonance (MR) probe for the in vivo characterization of the different stages of AAAs. METHODS AND RESULTS: AAAs spontaneously developed in ApoE-/- mice following the infusion of angiotensin-II (Ang-II, 1 µg/kg-1·per minute). An established fibrin-specific molecular MR probe (EP2104R, 10 µmol/kg-1) was administered after 1 to 4 weeks following Ang-II infusion (n=8 per group). All imaging experiments were performed on a clinical 3T Achieva MR system with a microscopy coil (Philips Healthcare, Netherlands). The development of AAA-associated fibrin-rich hematoma and thrombi was assessed. The high signal generated by the fibrin probe enabled high-resolution MR imaging for an accurate assessment and quantification of the relative fibrin composition of focal hematoma and thrombi. Contrast-to-noise-ratios (CNRs) and R1-relaxation rates following the administration of the fibrin probe were in good agreement with ex vivo immunohistomorphometry (R2=0.83 and 0.85) and gadolinium concentrations determined by inductively coupled plasma mass spectroscopy (R2=0.78 and 0.72). CONCLUSIONS: The fibrin-specific molecular MR probe allowed the delineation and quantification of changes in fibrin content in early and advanced AAAs. Fibrin MRI could provide a novel in vivo biomarker to improve the risk stratification of patients with aortic aneurysms.

Dividing Attention Between Tasks: Testing Whether Explicit Payoff Functions Elicit Optimal Dual-Task Performance.

We test people's ability to optimize performance across two concurrent tasks. Participants performed a number entry task while controlling a randomly moving cursor with a joystick. Participants received explicit feedback on their performance on these tasks in the form of a single combined score. This payoff function was varied between conditions to change the value of one task relative to the other. We found that participants adapted their strategy for interleaving the two tasks, by varying how long they spent on one task before switching to the other, in order to achieve the near maximum payoff available in each condition. In a second experiment, we show that this behavior is learned quickly (within 2-3 min over several discrete trials) and remained stable for as long as the payoff function did not change. The results of this work show that people are adaptive and flexible in how they prioritize and allocate attention in a dual-task setting. However, it also demonstrates some of the limits regarding people's ability to optimize payoff functions.

Training eye movements for visual search in individuals with macular degeneration.

We report a method to train individuals with central field loss due to macular degeneration to improve the efficiency of visual search. Our method requires participants to make a same/different judgment on two simple silhouettes. One silhouette is presented in an area that falls within the binocular scotoma while they are fixating the center of the screen with their preferred retinal locus (PRL); the other silhouette is presented diametrically opposite within the intact visual field. Over the course of 480 trials (approximately 6 hr), we gradually reduced the amount of time that participants have to make a saccade and judge the similarity of stimuli. This requires that they direct their PRL first toward the stimulus that is initially hidden behind the scotoma. Results from nine participants show that all participants could complete the task faster with training without sacrificing accuracy on the same/different judgment task. Although a majority of participants were able to direct their PRL toward the initially hidden stimulus, the ability to do so varied between participants. Specifically, six of nine participants made faster saccades with training. A smaller set (four of nine) made accurate saccades inside or close to the target area and retained this strategy 2 to 3 months after training. Subjective reports suggest that training increased awareness of the scotoma location for some individuals. However, training did not transfer to a different visual search task. Nevertheless, our study suggests that increasing scotoma awareness and training participants to look toward their scotoma may help them acquire missing information.

Prolonged Clopidogrel Use is Associated with Improved Clinical Outcomes Following Drug-Eluting But Not Bare Metal Stent Implantation.

BACKGROUND: Guidelines recommend clopidogrel use for 6-12 months following drug-eluting stent (DES) implantation and 1-12 months following bare metal stent (BMS) implantation. The role of clopidogrel beyond 12 months is unclear. METHODS: We linked hospital administrative, community pharmacy and cardiac revascularization data to determine clopidogrel use and outcomes for all patients (those with acute presentations and those with stable angina) receiving a coronary stent in British Columbia 2004-2006, with follow-up until the end of 2008. Cox proportional hazard regression was performed to evaluate the effect of clopidogrel duration (≤12 vs. >12 months) on outcomes following BMS or DES implantation. Patients who died ≤12 months from index stent placement were excluded. RESULTS: A total of 15,629 patients were included in the study. Of 3599 patients who received at least one DES and 12,030 patients who received only BMS, 1326 (37 %) and 2121 (18 %), respectively, filled a prescription for clopidogrel >12 months from the index procedure. The mean duration of clopidogrel was 406 ± 35 days and 407 ± 37 days in the prolonged use (>12 months) DES and BMS cohorts, respectively, compared with 224 ± 112 days (p < 0.001) and 122 ± 117 days (p < 0.001), respectively, for patients receiving clopidogrel ≤12 months. Clopidogrel use beyond 12 months was associated with a reduction in mortality [hazard ratio (HR) 0.66, 95 % confidence interval (CI) 0.45-0.97] and the composite of mortality and readmission for myocardial infarction (HR 0.72, 95 % CI 0.55-0.94) in patients treated with DES, but not BMS alone. Prolonged clopidogrel use was not associated with bleeding-related mortality. CONCLUSIONS: Clopidogrel use beyond 12 months was associated with a reduction in death and hospitalization for myocardial infarction following DES, but not BMS, implantation. Our findings support a longer duration of clopidogrel therapy for patients treated with DES.

Strategic Adaptation to Task Characteristics, Incentives, and Individual Differences in Dual-Tasking.

We investigate how good people are at multitasking by comparing behavior to a prediction of the optimal strategy for dividing attention between two concurrent tasks. In our experiment, 24 participants had to interleave entering digits on a keyboard with controlling a randomly moving cursor with a joystick. The difficulty of the tracking task was systematically varied as a within-subjects factor. Participants were also exposed to different explicit reward functions that varied the relative importance of the tracking task relative to the typing task (between-subjects). Results demonstrate that these changes in task characteristics and monetary incentives, together with individual differences in typing ability, influenced how participants choose to interleave tasks. This change in strategy then affected their performance on each task. A computational cognitive model was used to predict performance for a wide set of alternative strategies for how participants might have possibly interleaved tasks. This allowed for predictions of optimal performance to be derived, given the constraints placed on performance by the task and cognition. A comparison of human behavior with the predicted optimal strategy shows that participants behaved near optimally. Our findings have implications for the design and evaluation of technology for multitasking situations, as consideration should be given to the characteristics of the task, but also to how different users might use technology depending on their individual characteristics and their priorities.

Stop before you saccade: Looking into an artificial peripheral scotoma.

We investigated whether adults with healthy vision can move their eyes toward an informative target area that is initially hidden by a gaze-contingent scotoma in the periphery when they are under time pressure. In the experimental task, participants had to perform an object-comparison task requiring a same-different judgment about two silhouettes. One silhouette was visible, whereas the other was hidden under the scotoma. Despite time pressure and the presence of the visible silhouette, most participants were able to move their eyes toward the informative region to reveal the hidden silhouette. Saccades to the hidden stimulus occurred when the visible stimulus was presented directly opposite in either fixed or variable locations and when the visible stimulus was presented at an adjacent location. Older participants were also able to perform this task. First saccades in the direction of the hidden stimulus had longer latencies compared with saccades toward the visible stimulus. This suggests the use of a deliberate, nonreflexive saccade strategy ("stop before you saccade"). A subset of participants occasionally made curved saccades that were aimed first toward the visible stimulus and then toward the hidden stimulus. We discuss the implications of our findings for patients who have a biological scotoma, for example, in macular degeneration.

Sharing a driver's context with a caller via continuous audio cues to increase awareness about driver state.

In an experiment using a driving simulator we investigated whether sharing information of a driver's context with a remote caller via continuous audio cues can make callers more aware of the driving situation. Increased awareness could potentially help in making the conversation less distracting. Prior research has shown that although sharing context using video can create such beneficial effects, it also has some practical disadvantages. It is an open question whether other modalities might also provide sufficient context for a caller. In particular, the effects of sharing audio, a cheaper, more salient, and perhaps more practical alternative than video, are not well understood. We investigated sharing context using direct cues in the form of realistic driving sounds (e.g., car honks, sirens) and indirect cues in the form of elevated heartbeats. Sound sharing affected the caller's perception of the driver's busyness. However, this had at most a modest effect on conversation and driving performance. An implication of these results is that although sharing sounds can increase a caller's awareness of changes in the driver's busyness, they need more training or information on how to leverage such context information to reduce disruption to driving. Limitations and implications are discussed.

Delay in filling first clopidogrel prescription after coronary stenting is associated with an increased risk of death and myocardial infarction.

BACKGROUND: Patients frequently experience difficulties with medication compliance after hospital discharge. We investigated the effect of a delay in filling a first clopidogrel prescription after hospital discharge on clinical outcomes subsequent to coronary stenting. METHODS AND RESULTS: Hospital administrative, community pharmacy, and cardiac revascularization data were determined for all patients receiving a coronary stent in British Columbia 2004-2006 with follow-up out to 2 years. Cox's proportional hazard regression analysis, adjusting for baseline demographics and procedural variables, was performed to examine the effects of delay in filling a clopidogrel prescription after hospital discharge on clinical outcomes.Of 15 629 patients treated with coronary stents, 3599 received at least 1 drug-eluting stent (DES), whereas 12 030 received bare metal stents (BMS) alone. In total, 1064 (30%) and 3758 (31%) patients in the DES and BMS groups, respectively, failed to fill a prescription within 3 days of discharge (median, 1 day; interquartile range [IQR], 1 to 3). After regression analysis, a delay of >3 days was predictive of mortality and recurrent myocardial infarction (MI) irrespective of stent type (DES: hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.7 to 3.4; and HR, 2.0; 95% CI, 1.5 to 2.7, respectively, and BMS: HR, 2.2; 95% CI, 1.9 to 2.6; and HR, 1.8; 95% CI, 1.5 to 2.1, respectively). This excess hazard was greatest in the 30-day period immediately after hospital discharge (mortality: HR, 5.5; 95% CI, 3.5 to 8.6; and MI: HR, 3.1; 95% CI, 2.4 to 4.0, for all patients). CONCLUSIONS: Delays in patients filling their first prescription for clopidogrel after coronary stenting are common and associated with adverse clinical outcomes, irrespective of stent type. Strategies to reduce delays have the potential to improve clinical outcomes.