IN-HOSPITAL SYMPTOMS OF PSYCHOLOGICAL STRESS AS PREDICTORS OF LONG-TERM OUTCOME AFTER ACUTE MYOCARDIAL-INFARCTION IN MEN

The impact of high levels of psychological stress symptoms in the hospital after an acute myocardial infarction (AMI) was examined over 5 years among 461 men who took part in a trial of psychological stress monitoring and intervention. Psychological stress was assessed using the 20-item General Health Questionnaire (GHQ) 1 to 2 days before hospital discharge. Once discharged, patients in the treatment group responded to the GHQ by telephone on a monthly basis and, when they reported high levels of stress symptoms (GHQ greater-than-or-equal-to 5), received visits from nurses to help them deal with their life problems. Control patients received routine medical care after discharge. Post-hoc subgroup analyses based on life-table methods showed that, for patients receiving routine care after discharge, high stress (GHQ greater-than-or-equal-to 5) was associated with a close to threefold increase in risk of cardiac mortality over 5 years (p = 0.0003) and an approximately 1.5-fold increase in risk of reinfarction over the same period (p = 0.09). In contrast, highly stressed patients who took part in the 1-year program of stress monitoring and intervention did not experience any significant long-term increase in risk. Although program impact was significant in terms of reduction of both cardiac mortality (p = 0.006) and AMI recurrences (p = 0.004) among highly stressed patients, there was little evidence of impact among patients with low levels of stress in the hospital. These results add to the growing body of research implicating psychosocial factors in post-AMI outcomes, and suggest that the patients who can benefit most from interventions to alter these factors may be identified before hospital discharge.