RANDOMIZED TRIAL OF HOME-BASED PSYCHOSOCIAL NURSING INTERVENTION FOR PATIENTS RECOVERING FROM MYOCARDIAL-INFARCTION

Background Increases in life stress have been linked to poor prognosis after myocardial infarction (MI). Previous research suggested that a programme of monthly screening for psychological distress, combined wi th supportive and educational home nursing interventions for distresse d patients, may improve post-MI survival among men. Our study assessed this approach for both men and women. We aimed to find out whether th e programme would reduce 1-year cardiac mortality for women and men. M ethods We carried out a randomised, controlled trial of 1376 post-MI p atients (903 men, 473 women) assigned to the intervention programme (n =692) or usual care (n=684) for 1 year. All patients completed a basel ine interview that included assessment of depression and anxiety. Surv ivors were also interviewed at 1 year. Findings The programme had no o verall survival impact. Preplanned analyses showed higher cardiac (9.4 vs 5.0%, p=0.064) and all-cause mortality (10.3 vs 5.4%, p=0.051) amo ng women in the intervention group. There was no evidence of either be nefit or harm among men (cardiac mortality 2.4 vs 2.5%, p=0.94; all-ca use mortality 3.1 vs 3.1%, p=0.93). The programme's impact on depressi on and anxiety among survivors was small. Interpretation Our results d o not warrant the routine implementation of programmes that involve ps ychological-distress screening and home nursing intervention for patie nts recovering from MI. The poorer overall outcome for women, and the possible harmful impact of the intervention on women, underline the ne ed for further research and the inclusion of adequate numbers of women in future post-MI trials.