Psychosocial factors in patients with ischemic heart disease

Sammanfattning: PSYCHOSOClAL FACTORS IN PATIENTS WITH ISCHEMIC HEART DISEASE.Ewa Billing, Karolinska Institute, Danderyd Hospital, Department of Medicine, Danderyd, Sweden.. The aim of the study was to evaluate psychosocial variables in patients with ischemic heartdisease and the relationships between psychosocial variables and severity and prognosis of disease.Patients with stable angina pectoris and patients with a first myocardial infarction were included, and theevaluations were performed by two different methods. The angina population consisted of 767 patients(236 women) <70 years, who participated in the Angina Prognosis Study In Stockholm (APSIS), wheretreatment with two anti-ischemic drugs, metoprolol or verapamil were compared. Psychosocial variableswere evaluated by structured interviews, concerning psychosomatic symptom, sleep disturbances, overalllife satisfaction, job strain, type-A behaviour and previous life events, at their inclusion into the study andat their last visit, (follow-up time 6 - 75 months). The population with myocardial infarction includedmale patients in two different countries (98 patients in Sweden and 87 patients in Israel) < 60 years with afirst myocardial infarction. The patients were interviewed during their hospital stay, and after 6 months, aswere the patient's spouse and treating physician. The three groups were asked two questions: "Why do youthink the myocardial infarction happened to you/him?" and "What will help you/him cope with it?", andthey replied by using two sets of Q-sort cards with 20 possible answers to either question, the "causalattribution". The patients were furthermore asked if they had experienced any previous serious life events,and at the same time their level of denial and depression was rated on a three degree scale by theinterviewer.Psychosocial variables which are previously discussed as being risk factors for myocardial infarction, aremore common in patients with stable angina pectoris than in controls, and differ between female andmale patients. Ex-smokers had a better prognosis than smokers and non-smokers, and sexual problemswere significantly related to cardiovascular death. Problems with sexual life were not related to age orseverity of angina. The severity of angina pectoris did not seem to relate to life satisfaction or atdtudestowards the future. In the populadon of patients with myocardial infarction some common backgroundfactors were shown to be of prognosdc value. Further more, the patients' and their spouses' attributionconcerning what caused the myocardial infarction and their ideas about coping predicted the patients'ability to make life style changes, and the subjective and objecdve outcome 6 months after the myocardialinfarction. The physicians who more attributed the patients' myocardial infarction to medical causes, didnot predict the patients' outcome to the same extent.Psychosocial variables are shown to be important for the development of ischemic heart disease.Correlations between psychosocial variables and objective signs of ischemic heart disease are poor,although psychosocial variables also heavily influence outcome and prognosis.Key-words: Iscemic beart disease, myocardial infarction, angina pectoris, psycbosocial variables,job strain, sleep disturbances, psycbosomatic symptoms, type-A bebaviour, causal attribution, outcomeISBN 91-628-2144-X