title: The effect of a home-based, case-managed, multifactorial risk-reduction program on reducing psychological distress in patients with cardiovascular disease.
abstract: BACKGROUND
  This study examined the effects of a nurse-case-managed, multifactorial, risk-reduction program on psychological distress among patients after myocardial infarction (MI).
  
  
  METHODS
  Five hundred eighty-five men and women aged 70 years or younger, who were hospitalized for acute MI in one of five San Francisco Bay Area hospitals, were randomized to receive a nurse-managed, home-based, multifactorial risk-reduction program (n = 293) or usual care (n = 292). The program, which began in the hospital, included a brief screen for five areas of psychological distress with further evaluation if indicated, monitoring during the follow-up phone calls, and referral for mental health treatment if needed. Patients were assessed with single-item scales at baseline, and at 6 and 12 months. Separate analyses were performed for patients with moderate-to-severe levels on the psychological distress domains and for those with low levels.
  
  
  RESULTS
  There was a significant reduction in the psychological distress variables for all patient groups between baseline and 12 months. The program had a significant effect on reducing anxiety in the patient group with low levels of anxiety and reducing anger in the patient group with frequent episodes of anger but, overall, the treatment and control groups showed equal levels of improvement.
  
  
  CONCLUSIONS
  Among patients post-MI without complications, psychological distress decreases significantly during the 12 months after MI.
authors.affiliation: Stanford Cardiac Rehabilitation Program, Stanford University School of Medicine, CA 94305-5542, USA.
authors.forename: C B
authors.initials: CB
authors.lastname: Taylor
authors.forename: N H
authors.initials: NH
authors.lastname: Miller
authors.forename: P M
authors.initials: PM
authors.lastname: Smith
authors.forename: R F
authors.initials: RF
authors.lastname: DeBusk
mesh_terms: D000368:Aged; D019090:Case Management / Q000458:organization & administration*; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009203:Myocardial Infarction / Q000523:psychology*; D009730:Nursing Assessment; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D013315:Stress, Psychological / Q000209:etiology / Q000451:nursing* / Q000517:prevention & control*