Stress management in cardiac patients: a preliminary study of the predictors of improvement in quality of life.

The effects on quality of life of a 12-wk relaxation-based stress management programme emphasizing improvements in self-confidence and control was assessed in seventy-eight patients following myocardial infarction, coronary artery bypass surgery or coronary angioplasty. Measures of psychological state, functional mobility level, social activity and chest pain were obtained before and after treatment and at 6 month follow-up. Fifty-one (66%) of patients completed the programme. Significant reductions in anxiety and depression and improvements in psychological general well-being, activities of daily living, social activity, quality of interactions and satisfaction with sexual relationships were observed posttreatment, and these were largely maintained at follow-up. Reductions in chest pain and improvements in spouse ratings of psychological state were also recorded. Similar responses were measured in myocardial infarction and surgery patients. Predictors of outcome in three aspects of quality of life, anxiety, activities of daily living and social activity, were assessed. Improvements in these three domains were independent of one another, and their predictors were also different. Reductions in anxiety were associated with neurotic dispositions and openness to new experience, while improvements in activities of daily living were predicted by work status, age and time since infarction or surgery. Implications for the use of stress management in cardiac rehabilitation are discussed.