Clinical implications of a reduction in psychological distress on cardiac prognosis in patients participating in a psychosocial intervention program.
OBJECTIVE
The objective of this secondary analysis was to examine the relationships between a reduction in psychological distress and long-term cardiac and psychological outcomes in post-myocardial infarction patients who participated in a randomized trial of home-based psychosocial nursing interventions (the Montreal Heart Attack Readjustment Trial [M-HART]). Gender differences were considered.


METHODS
We studied 433 patients (36.0% women) from the M-HART treatment group who received two home visits after achieving a high psychological distress score (ie, > or =5) on the General Health Questionnaire (GHQ). Short-term GHQ success was determined by a return to a normal GHQ score (<5) or a reduction of > or =50% after the two visits. Patients with short-term successful and unsuccessful GHQ outcomes were compared for mid-term maintenance of success, 1-year death and readmission rates, and 1-year depression and anxiety symptoms.


RESULTS
Patients with short-term GHQ success were more likely to show mid-term GHQ success (p < .001), marginally less likely to die of any causes (p = .087), less likely to die of cardiac causes (p = .043), less likely to be readmitted for any reason (p < .001) and for cardiac reasons (p < .001), and less likely to have high depression (p < .001) and anxiety (p < .001) at 1-year than patients with short-term unsuccessful GHQ outcomes. Results held for men and women and were not altered by controlling for potential confounders. However, the number of deaths prevented analysis with statistical controls.


CONCLUSIONS
Post-myocardial infarction interventions that reduce psychological distress have the potential to improve long-term prognosis and psychological status for both men and women.
Cossette
S
S
Faculty of Nursing, University of Montreal, Research Center, Montreal Heart Institute, QC, Canada. cossets@scinf.umontreal.ca
Frasure-Smith
N
N
Lespérance
F
F
D000368:Aged; D001007:Anxiety / Q000209:etiology; D002170:Canada / Q000453:epidemiology; D003152:Community Health Nursing; D003863:Depression / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000523:psychology* / Q000534:rehabilitation*; D010359:Patient Readmission; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011614:Psychotherapy, Brief / Q000379:methods*; D013315:Stress, Psychological / Q000628:therapy*; D016896:Treatment Outcome