FUNCTIONAL RECOVERY AFTER MYOCARDIAL-INFARCTION IN MEN - THE INDEPENDENT EFFECTS OF SOCIAL-CLASS

Background: Social class has been repeatedly associated with cardiovas cular-related illness and death, but no studies have examined the effe ct of social class on recovery from myocardial infarction. Moreover, f ew studies have simultaneously evaluated a broad array of demographic, clinical, and psychosocial factors that may influence health outcomes after myocardial infarction. Objective: To determine whether social c lass remains independently associated with functional recovery after m yocardial infarction, even after controlling for clinical, demographic , and psychosocial factors known to influence outcomes after infarctio n. Design: Analysis of prospective data from a multicenter, randomized , double-blind clinical trial. Setting: 25 hospitals or clinical setti ngs in the United States and Canada that participated in the Beta Bloc ker Heart Attack Trial, including the Health Insurance Plan substudy. Patients: 2145 men 29 to 69 years of age who were hospitalized with ac ute myocardial infarction and were recruited into the Beta Blocker Hea rt Attack Trial.Measurements: The primary outcome was change in New Yo rk Heart Association functional class between baseline assessment and 12 months after infarction, dichotomized as improved or not improved ( that is, no change, decline in at least one category, or death). Resul ts: Social class maintained its independent effect on improved functio nal status, even after controlling for pertinent prognostic factors. P ersons of high social class were significantly more likely than person s of low or middle social class to have improved functional status 1 y ear after infarction. Certain clinical, demographic, and psychosocial features were related to recovery, but the effect of social class coul d not be explained by these additional features. Conclusions: Social c lass has a substantial influence on recovery from myocardial infarctio n and may explain differences in clinical outcomes.