Prognostic importance of low social support and changes in social support for patient-centered outcomes after acute myocardial infarction.

摘要

Background. Social support (SS) predicts outcomes after acute myocardial infarction (AMI). However, much of the evidence supporting this relationship does not assess patient-centered outcomes, including health status (angina, quality of life, functional status), depressive symptoms, and adherence to risk factor management (RFM), or examine the importance of potential changes in SS during the early recovery period for outcomes within the first year of recovery.;Methods. This dissertation includes three studies utilizing data from the Prospective Registry Evaluating Myocardial Infarction: Events and Recovery, a 19-center prospective cohort of 2498 patients hospitalized for AMI between 2003 and 2004. Participants were interviewed at hospital presentation (baseline) and at 1, 6, and 12 months. Study I longitudinally examines the association of baseline SS with health status and depressive symptoms over the first year and assesses whether sex modifies these associations. Study II examines changes in SS between baseline and 1 month and determines the importance of these changes for health status and depressive symptoms over the first year. Study III longitudinally examines the association of baseline SS and changes in SS between baseline and 1 month with RFM adherence over the first year and assesses whether depression modifies these associations.;Results. Study I: Lower baseline SS was associated with worse health status and more depressive symptoms over the first year, particularly for women. Study II: Subgroups of AMI patients experienced changes in SS during early recovery, and these changes were independently predictive of outcomes. SS assessment at l month was more strongly associated with health status and depressive symptoms over the first year than assessment at baseline. Study III: Low baseline SS was associated with poorer RFM adherence over the first year, with changes in SS independently predicting adherence and associations moderated by depression.;Conclusion. Low SS and changes in SS are related to a broad range of patient-centered outcomes over the first year of AMI recovery. However, these relationships are potentially moderated by sex and depression. These results provide a basis upon which to explore the development and effective implementation of interventions to increase SS for the purpose of improving AMI outcomes.