[Clinical outcome and psychosocial adjustment 10-13 years after a first acute myocardial infarction: preliminary findings].

UNLABELLED

Preliminary findings of the previousLy described followup study of myocardial infarction (MI) are summarized herein. All-cause mortality was 28%. One or more cardiac events occurred in 83% of the patients: recurrent MI in 31%; unstable angina pectoris in 52%; heart failure in 23%. Coronary artery bypass surgery was performed in 35% and coronary angioplasty in 38% of the patients. Recurrence of angina/MI was observed in 55% of patients treated with bypass surgery and in 75% of those treated with angioplasty. Stroke occurred in 14% of the cohort. At the fifth interview, anginal symptoms were reported by one third of survivors and left ventricular dysfunction was found in almost half of the patients. Self-reported compliance with diet and exercise was 36% and 44%, respectively. Adequate control of blood cholesterol was 25%, of hypertension - 57%; and of diabetes - 51%. Smoking rate among smokers at the index MI was 42%. Participation in cardiac rehabiLitation at any time since the index infarction was less than 20%. Resumption of work and sexual activity among previously active participants was 83% and 87%, respectively. At the fifth interview, 44% of survivors were employed and 65% were sexually active. Health-related quality of life was inferior in female participants compared with male participants and a normative sample of women. Outcomes of all categories were predicted by sociodemographic, clinical, and psychosocial variables.

CONCLUSIONS

In a long-term follow-up of post-MI patients, cardiac events occurred in most participants, risk factors were not adequately controlled and participation in cardiac rehabilitation was poor. Psychosocial and socioeconomic measures had an impact on all outcomes.

RECOMMENDATIONS

(A) Further development of cardiac rehabilitation and secondary prevention services in Israel is essential; (B) psychosocial evaluation of cardiac patients should be incorporated into their routine assessment and the findings should be applied to preventive and rehabilitative care; (C) preventive services for low socioeconomic individuals should receive a high priority.