Psychosocial factors in patients with ischemic heart disease

The aim of the study was to evaluate psychosocial variables in patients with ischemic heart disease 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 the evaluations 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), where treatment with two anti-ischemic drugs, metoprolol or verapamil were compared. Psychosocial variables were evaluated by structured interviews, concerning psychosomatic symptom, sleep disturbances, overall life satisfaction, job strain, type-A behaviour and previous life events, at their inclusion into the study and at their last visit, (follow-up time 6 - 75 months). The population with myocardial infarction included male patients in two different countries (98 patients in Sweden and 87 patients in Israel) < 60 years with a first myocardial infarction.

The patients were interviewed during their hospital stay, and after 6 months, as were 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?", and they replied by using two sets of Q-sort cards with 20 possible answers to either question, the "causal attribution". 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 the interviewer. Psychosocial variables which are previously discussed as being risk factors for myocardial infarction, are more 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 problems were significantly related to cardiovascular death. Problems with sexual life were not related to age or severity of angina.

The severity of angina pectoris did not seem to relate to life satisfaction or attitudes towards the future. In the population of patients with myocardial infarction some common background factors were shown to be of prognostic value. Furthermore, the patients' and their spouses' attribution concerning what caused the myocardial infarction and their ideas about coping predicted the patients' ability to make life style changes, and the subjective and objective outcome 6 months after the myocardial infarction. The physicians who more attributed the patients' myocardial infarction to medical causes, did not 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.