title: Perceived adequacy of tangible social support and health outcomes in patients with coronary artery disease.
abstract: OBJECTIVE
  Health outcomes of patients with chronic disease might be influenced by assistance from others in performing daily activities. We examined whether perceived adequacy of such tangible support was associated with prognosis in a cohort of patients with coronary artery disease.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  In spring 1993, a cohort of 1,468 patients with chronic artery disease was identified using claims data. The cohort consisted of all surviving residents of Manitoba, Canada, who had been hospitalized for acute myocardial infarction from 1991 to 1992: 820 patients completed the initial survey, and 734 completed a follow-up survey approximately 1 year later.
  
  
  RESULTS
  Adequacy of tangible support was assessed by asking if respondents needed help at home because of health problems, and whether these needs were met. We examined the association between perceived adequacy of tangible support and health outcomes at 1 year (mortality, physical function). Of 820 participants, 74% perceived no need for help, 13% had sufficient help, 9% needed more help, and 5% needed much more help; 31 patients died during follow-up. After adjustment for age and initial health status, odds ratios (95% confidence interval) for death were: sufficient help 1.8 (0.61, 5.8); need more help 3.2 (1.1, 9.4); and need much more help 6.5 (2.0, 21.6) compared with respondents with no perceived need. Decline in physical function was also linearly related to perceiving less-adequate tangible support. Sensitivity analyses indicated it is highly improbable that results were due to selection bias.
  
  
  CONCLUSIONS
  Perceived lack of needed assistance was related to mortality and to decline in physical functioning. Adequacy of tangible support was an important prognostic factor for these patients with coronary artery disease and may be a determinant of health outcomes.
authors.affiliation: Department of Veterans Affairs Medical Center, White River Junction, Vt. 05009, USA.
authors.forename: S
authors.initials: S
authors.lastname: Woloshin
authors.forename: L M
authors.initials: LM
authors.lastname: Schwartz
authors.forename: A N
authors.initials: AN
authors.lastname: Tosteson
authors.forename: C H
authors.initials: CH
authors.lastname: Chang
authors.forename: B
authors.initials: B
authors.lastname: Wright
authors.forename: J
authors.initials: J
authors.lastname: Plohman
authors.forename: E S
authors.initials: ES
authors.lastname: Fisher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality / Q000534:rehabilitation*; D003625:Data Collection; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D011788:Quality of Life; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012944:Social Support; D015996:Survival Rate; D016896:Treatment Outcome