The effect of a psychosocial intervention and quality of life after acute myocardial infarction: the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial.
OBJECTIVE
The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) clinical trial was designed to test whether intervening on depression or low perceived social support reduces mortality and reinfarction in patients with acute myocardial infarction (MI). This report analyzes the effect of the intervention on quality of life (QOL), which was an important secondary outcome.


METHODS
ENRICHD was a randomized controlled clinical trial comparing a psychosocial intervention based on cognitive behavioral therapy to usual medical care in 2,481 patients from 8 clinical centers. Patients with acute MI were included if they met criteria for depression, low perceived social support, or both. QOL was assessed at the 6-month clinic visit in the first 1,296 patients. QOL measures included the Medical Outcomes Study Short Form summary measures of physical functioning (SF12-PCS) and mental functioning (SF12-MCS), a Life Satisfaction Scale (LSS), and a measure of overall QOL based on the ladder of life (LOL) technique.


RESULTS
There were significant treatment differences on the SF12-MCS (difference 2.2, 95% confidence interval [CI] 1.2-3.2), the LSS (difference 1.0, 95% CI 0.5-1.5), and the LOL (difference 0.3, 95% CI 0.1-0.6), but not on the SF12-PCS (difference 0.8; 95% CI = -0.5-2.0). Effect sizes for the intervention on QOL outcomes were modest.


CONCLUSIONS
Psychosocial interventions of limited duration confer modest QOL benefits in post-MI patients who are depressed or have low perceived social support. Interventions of longer duration or greater intensity may be required to produce more substantial improvements in QOL in these patients.
Mendes de Leon
Carlos F
CF
Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois 60612, USA. cmendes@rush.edu
Czajkowski
Susan M
SM
Freedland
Kenneth E
KE
Bang
Heejung
H
Powell
Lynda H
LH
Wu
Colin
C
Burg
Matthew M
MM
DiLillo
Vicki
V
Ironson
Gail
G
Krumholz
Harlan M
HM
Mitchell
Pamela
P
Blumenthal
James A
JA
D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000209:etiology / Q000523:psychology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome