Long-term follow-up of the Ischemic Heart Disease Life Stress Monitoring Program.

Abstract

This study examines patient outcomes up to seven years after a one-year, post-myocardial infarction (MI) stress monitoring and management program. A previous randomized controlled trial involving 461 male patients demonstrated that the program lowered stress scores and reduced one-year cardiac deaths by almost 50%, but made no difference in readmission rates or durations. The present study used medical records to assess the durability of these outcomes. Results indicated that the difference in cardiac deaths was primarily due to out-of-hospital deaths (that is, those that were more likely to have been sudden deaths) and persisted for six months beyond the end of the program, after which the mortality curves began to approach one another. In addition, although during the program year MI recurrences occurred at the same rate in the two groups, during the years after the program there were fewer MI recurrences among the treated patients. Over the full follow-up period the group difference in MI recurrences was statistically significant (p = 0.043). Results are considered in terms of methodological limitations of the study, including the timing of randomization, sample selection requirements, and group differences on baseline variables. Findings are also discussed in relation to the outcomes of other programs producing long-term reductions in recurrences or deaths from ischemic heart disease. It is suggested that, regardless of their approach, all such programs may share a common therapeutic mechanism: the provision of emotional support during a period of high vulnerability to stress.