Clinical implications of a reduction in psychological distress on cardiac prognosis in patients participating in a psychosocial intervention program

Objective: The objective of this secondary analysis was to examine the rela tionships between a reduction in psychological distress and long-term cardi ac and psychological outcomes in post-myocardial infarction patients who pa rticipated in a randomized trial of home-based psychosocial nursing interve ntions (the Montreal Heart Attack Readjustment Trial [M-HART]), Gender diff erences were considered. Methods: We studied 433 patients (36.0% women) fro m the M-HART treatment group who received two home visits after achieving a high psychological distress score Iie, greater than or equal to5) on the G eneral Health Questionnaire (GHQ). Short-term GHQ success was determined by a return to a normal GHQ score (<5) or a reduction of >50% after the two v isits. Patients with short-term successful and unsuccessful GHQ outcomes we re compared for mid-term maintenance of success, 1-year death and readmissi on rates, and 1-year depression and anxiety symptoms. Results: Patients wit h short-term GHQ success were more likely to show mid-term GHQ success (p < .001), marginally less likely to die of any causes (p =.087), less likely to die of cardiac causes (p =.043), less likely to be: readmitted for an) r eason (p < .001) and for cardiac reasons (p <.001], and less likely to have high depression (p (.001) and anxiety (p (.001) at 1-year than patients wi th short-term unsuccessful GHQ outcomes. Results held for men and women and were not altered bycontrolling for potential confounders. However, the num ber of deaths prevented analysis with statistical controls. Conclusions: Po st-myocardial infarction interventions that reduce psychological distress h ave the potential to improve long-term prognosis and psychological status f or both men and women.