[Clinical outcome and psychosocial adjustment 10-13 years after a first acute myocardial infarction: preliminary findings].

UNLABELLED: Preliminary findings of the previousLy described followup study of myocardial infarction (MI) are summarized herein. All-cause mortality was 28%. One or more cardiac events occurred in 83% of the patients: recurrent MI in 31%; unstable angina pectoris in 52%; heart failure in 23%. Coronary artery bypass surgery was performed in 35% and coronary angioplasty in 38% of the patients. Recurrence of angina/MI was observed in 55% of patients treated with bypass surgery and in 75% of those treated with angioplasty. Stroke occurred in 14% of the cohort. At the fifth interview, anginal symptoms were reported by one third of survivors and left ventricular dysfunction was found in almost half of the patients. Self-reported compliance with diet and exercise was 36% and 44%, respectively. Adequate control of blood cholesterol was 25%, of hypertension - 57%; and of diabetes - 51%. Smoking rate among smokers at the index MI was 42%. Participation in cardiac rehabiLitation at any time since the index infarction was less than 20%. Resumption of work and sexual activity among previously active participants was 83% and 87%, respectively. At the fifth interview, 44% of survivors were employed and 65% were sexually active. Health-related quality of life was inferior in female participants compared with male participants and a normative sample of women. Outcomes of all categories were predicted by sociodemographic, clinical, and psychosocial variables.

CONCLUSIONS

In a long-term follow-up of post-MI patients, cardiac events occurred in most participants, risk factors were not adequately controlled and participation in cardiac rehabilitation was poor. Psychosocial and socioeconomic measures had an impact on all outcomes.

RECOMMENDATIONS: (A) Further development of cardiac rehabilitation and secondary prevention services in Israel is essential; (B) psychosocial evaluation of cardiac patients should be incorporated into their routine assessment and the findings should be applied to preventive and rehabilitative care; (C) preventive services for low socioeconomic individuals should receive a high priority.