Modification of physical activity 5 months after myocardial infarction: relevance of biographic and personality characteristics

Feelings of being disabled as a risk factor for mortality up to 8 years after acute myocardial infarction

OBJECTIVE

We examined the independent prognostic value of the four subscales of the Heart Patients Psychological Questionnaire (HPPQ) on mortality in acute myocardial infarction (AMI) survivors up to 8 years after the event.

METHODS

The HPPQ, which measures well-being, feelings of being disabled, despondency and social inhibition, was administered to 567 AMI patients during hospitalisation and at 3 months follow-up. The patients were followed for 8 years.

RESULTS

During follow-up, 157 patients (28%) died. Forty-one percent of the patients had a score indicating at least mild to moderate feelings of being disabled. Patients with feelings of being disabled were at increased risk of mortality compared with those having a low score, adjusted for other cardiac risk factors [hazard ratio (HR)=1.8, 95% confidence interval (CI)=1.3-2.5]. There was no interaction between feelings of being disabled and gender. None of the other HPPQ subscales were related to mortality or recurrent myocardial infarction (MI). When the study population was stratified by low and high clinical risk (43% vs. 57%, respectively), feelings of being disabled was the most prominent predictor of mortality in the low-risk group (HR=3.5, 95% CI=1.4-8.8).

CONCLUSION

Feelings of being disabled measured at baseline and at 3 months was the most prominent predictor of mortality in low-risk patients 8 years post-MI. This finding adds to the existing knowledge that psychosocial variables influence morbidity and mortality in cardiac patients.

Feelings of being disabled as a predictor of mortality in men 10 years after percutaneous coronary transluminal angioplasty

OBJECTIVE

To examine the independent prognostic value of the four subscales of the Heart Patients Psychological Questionnaire (HPPQ) on mortality in male and female patients 10 years following percutaneous transluminal coronary angioplasty (PTCA).

METHODS

The HPPQ, which measures well-being, feelings of being disabled, despondency, and social inhibition, was administered to 356 patients (23% women) post-PTCA. The patients were followed for a median of 10 years. Clinical and demographic variables were sampled from medical records.

RESULTS

During the follow-up period, 104 patients (29%) had died. Women scored significantly worse on all psychological subscales compared with men. Fifty-nine (72%) women and 92 (34%) men had a score indicating at least mild to moderate feelings of being disabled. Men scoring high on feelings of being disabled were at increased risk of mortality compared with men having a low score, adjusted for other cardiac risk factors (chi(2)=7; P=.008). No differences were found between women with low or high scores on feelings of being disabled (relative risk (RR): 1.2; 95% confidence interval (CI): 0.5-3.3). None of the other HPPQ subscales were related to mortality.

CONCLUSION

Feelings of being disabled measured at least 1 year after hospital discharge is a significant predictor of mortality in men 10 years post-PTCA, but not in women. This finding adds to the increasing knowledge that psychosocial variables influence morbidity and mortality in cardiac patients.

Cardiac rehabilitation: a review of current developments

An overview is given of the current status of cardiac rehabilitation and its effects on morbidity and mortality. While there is an emphasis in most current programs upon physical exercise as an important autonomous risk factor for Coronary Heart Disease (CHD), there is at the same time a tendency in cardiac rehabilitation to go beyond mere physical exercise towards adding more multimodal psychoeducational modules in rehabilitation programs; those approaches are aimed at educating the patient about a less risky and healthier way of life. Such psycho-education is more and more aimed at the "toxic" aspects of negative emotions. The in-between classic Type A Behavior Pattern (TABP) might, in general, be less powerful in predicting later CHD morbidity or mortality than some specific emotional components of TABP, such as anger and hostility. The literature is reviewed as to risk factors and CHD and the role of negative affectivity in development and or maintenance of CHD. Approaches for modification are discussed against the background of their effectivity in cardiac rehabilitation. The recent Dutch guidelines, issued by the Dutch Heart Foundation, appear to incorporate many of the elements mentioned in the research literature on cardiac rehabilitation. On a scientific level they form an excellent audit to evaluate and to contour efficiently the until-now very heterogeneous field of cardiac rehabilitation.

Gender-linked personality traits predict mental health and functional status following a first coronary event

Three gender-linked traits were examined with respect to adjustment to a coronary event: agency, a focus on the self; communion, a focus on others; and unmitigated communion, an extreme focus on others to the exclusion of the self. Participants (n = 65) were interviewed 1 week and 4 months after a 1st coronary event. Hypotheses were that agency should predict improved health, communion should be unrelated to health, and unmitigated communion should predict worse health over time. Outcomes included depression, anxiety, and well-being (as measured by the Profile of Mood States; D. McNair, M. Lorr, & L. Droppleman, 1971); mental and physical functioning (SF-36; J. E. Ware, K. K. Snow, M. Kosinski, & B. Gandek, 1993); and cardiac symptoms. Results confirmed hypotheses. In addition, unmitigated communion was linked with poor health behavior and negative social interactions, which partly explained the link of unmitigated communion with depression and cardiac symptoms.