title: Prognostic importance and long-term determinants of self-rated health after initial acute myocardial infarction.
abstract: BACKGROUND
  Self-rated health (SRH) is a valid measure of health and its trajectories over time have been found to predict mortality. A better understanding of the determinants of changes in SRH is required, particularly post-myocardial infarction (MI), where rapid changes in health may occur.
  
  
  OBJECTIVE
  To evaluate the prognostic importance of SRH and the determinants of its long-term trajectory in patients with MI.
  
  
  METHODS
  Between February 1992 and February 1993, 1521 consecutive patients aged <or=65 years (19% women) discharged from all hospitals in central Israel after initial acute MI were enrolled and followed-up for a mean of 12 years. Extensive data were obtained at study entry, with SRH measured at baseline (retrospective assessment of pre-MI health status) and at 5 and 10 years.
  
  
  RESULTS
  Baseline SRH showed a strong graded association with mortality post-MI. The association was further strengthened when changes in SRH over time were taken into account. Using generalized estimating equations, independent predictors of poor SRH at follow-up were Asian/African origin, low education, poor income, low baseline SRH, comorbidity, impaired ejection fraction, diabetes, dyslipidemia, obesity, and physical inactivity. In a subsample with available psychosocial measures (n = 668), low social support and sense of coherence and high anxiety and depression were also predictive of poor SRH.
  
  
  CONCLUSIONS
  SRH is an important risk marker after MI and its long-term trajectory is accurately predicted by demographic, socioeconomic, clinical, and psychosocial measures. Monitoring of SRH post-MI is therefore warranted.
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Medical School, Tel Aviv University, Ramat Aviv, Tel Aviv, 69976, Israel. yarivg@post.tau.ac.il
authors.forename: Yariv
authors.initials: Y
authors.lastname: Gerber
authors.forename: Yael
authors.initials: Y
authors.lastname: Benyamini
authors.forename: Uri
authors.initials: U
authors.lastname: Goldbourt
authors.forename: Yaacov
authors.initials: Y
authors.lastname: Drory
mesh_terms: D000208:Acute Disease; D000328:Adult; D001294:Attitude to Health; D015897:Comorbidity; D003925:Diabetic Angiopathies; D050171:Dyslipidemias / Q000150:complications; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D007557:Israel / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000208:ethnology / Q000401:mortality / Q000523:psychology*; D009765:Obesity / Q000150:complications; D011379:Prognosis; D011446:Prospective Studies; D055500:Resilience, Psychological; D012649:Self Concept; D018434:Sickness Impact Profile; D012944:Social Support; D013318:Stroke Volume; D018754:Ventricular Dysfunction; D055815:Young Adult