In-hospital symptoms of psychological stress as predictors of long-term outcome after acute myocardial infarction in men

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Abstract

The impact of high levels of psychological stress symptoms in the hospital after an acute myocardial infarction (AMI) was examined over 5 years among 461 men who took part in a trial of psychological stress monitoring and intervention. Psychological stress was assessed using the 20-item General Health Questionnaire (GHQ) 1 to 2 days before hospital discharge. Once discharged, patients in the treatment group responded to the GHQ by telephone on a monthly basis and, when they reported high levels of stress symptoms (GHQ ≥ 5), received visits from nurses to help them deal with their life problems. Control patients received routine medical care after discharge. Post-hoc subgroup analyses based on life-table methods showed that, for patients receiving routine care after discharge, high stress (GHQ ≥ 5) was associated with a close to threefold increase in risk of cardiac mortality over 5 years (p = 0.0003) and an approximately 1.5fold increase in risk of reinfarction over the same period (p = 0.09). In contrast, highly stressed patients who took part in the 1-year program of stress monitoring and intervention did not experience any significant long-term increase in risk. Although program impact was significant in terms of reduction of both cardiac mortality (p = 0.006) and AMI recurrences (p = 0.004) among highly stressed patients, there was little evidence of impact among patients with low levels of stress in the hospital. These results add to the growing body of research implicating psychosocial factors in post-AMI outcomes, and suggest that the patients who can benefit most from interventions to alter these factors may be identified before hospital discharge.

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      Elevated anxiety symptoms have been shown to be associated with a 2-fold increased risk of mortality in patients who have had coronary artery bypass grafting and in outpatients with CHD.21-24 Frasure-Smith reported that patients with CHD and generalized anxiety disorder assessed 2 months after hospital discharge showed a 2.3-fold increased risk of adverse CVD events,25 and Strik et al.26 reported a 2.8-fold increased risk of adverse events in patients after an episode of acute infarction in which anxiety was measured 1 month after hospital discharge. Similarly, a 2-fold increased risk of adverse events was observed in patients with stable CHD and in patients with elevated anxiety during annual clinic visits.23,27

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    This research was supported by the National Health Research and Development Program of Canada through Projects 605-1303-44, 6605-2388-44 and 6605-2022-48.

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