THE INFLUENCE OF PSYCHOSOCIAL FACTORS ON SURVIVAL AFTER MYOCARDIAL-INFARCTION

The prognostic importance of psychosocial factors after acute myocardi al infarction (AMI) is still debated. A fourfold increase in risk of m ortality after AMI was reported for participants in the beta Blocker H eart Attack Trial who were described as being socially isolated and ha ving high levels of life stress. This study was designed to determine the influence of social isolation and/or life stress on mortality afte r AMI in an English population. It was a follow-up study of a subset o f patients recruited for the Anglo-Scandinavian Study of Early Thrombo lysis (ASSET), between November 1986 and February 1988. The study grou p comprised 1,376 patients with suspected AMI (1,073 men and 303 women ), from coronary care units in six English hospitals. Patients who wer e alive at 7 days and had completed a psychosocial questionnaire withi n seven days post-infarction were followed up for a median time of thr ee years, the sole outcome measure being death from all causes. All de aths were notified by the National Health Service Central Registry (NH SCR). Cox's regression was used to allow for independent clinical prog nostic factors such as age-group, previous documented infarct, complic ations in hospital, history of diabetes and history of hypertension. S ocially isolated patients (in terms of lack of membership of any club or religious group or lack of contact with family and friends) were 49 % more likely to die after an infarction than patients classified as n ot being socially isolated. While this statistic is of borderline sign ificance it does suggest that such patients are at an increased risk o f death after AMI. No associations with mortality risk were found with life-stress level, type A behaviour pattern or depression.