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Psychosocial Influences on Mortality after Myocardial Infarction

List of authors.
  • William Ruberman, M.D.,
  • Eve Weinblatt, A.B.,
  • Judith D. Goldberg, Sc.D.,
  • and Banvir S. Chaudhary, Ph.D.

Abstract

Psychosocial interviews with 2320 male survivors of acute myocardial infarction, participants in the β-Blocker Heart Attack Trial, permitted the definition of two variables strongly associated with an increased three-year mortality risk. With other important prognostic factors controlled for, the patients classified as being socially isolated and having a high degree of life stress had more than four times the risk of death of the men with low levels of both stress and isolation. An inverse association of education with mortality in this population reflected the gradient in the prevalence of the defined psychosocial characteristics. High levels of stress and social isolation were most prevalent among the least-educated men and least prevalent among the best-educated. The increase in risk associated with stress and social isolation applied both to total deaths and to sudden cardiac deaths and was noted among men with both high and low levels of ventricular ectopy during hospitalization for the acute infarction. (N Engl J Med 1984; 311:552–9.)

Funding and Disclosures

Supported by a grant (HL 24786) from the National Institutes of Health.

We are indebted to the clinical centers that cooperated in this study and in particular to the clinic coordinators who carried out the face-to-face interviews and responded with enthusiasm to the study's needs; to C. Morton Hawkins, Sc.D., and his staff at the Coordinating Center at the University of Texas in Houston, who were meticulous in meeting our needs for base-line and follow-up data for the Health Insurance Plan–BHAT study subjects; to Curt D. Furberg, M.D., and Lawrence M. Friedman, M.D., of the National Heart, Lung, and Blood Institute; and Sidney Goldstein, M.D., chairman of the BHAT Steering Committee, who provided help and advice both in the initiation of the study and in the development of necessary administrative arrangements.

The clinical centers, principal investigators, and clinic coordinators participating in the Health Insurance Plan–BHAT ancillary study were as follows: Baylor College of Medicine, Houston — Craig M. Pratt, M.D., Charlotte Payton-Ross; Brown University Affiliated Hospitals, Providence, R.I. — Robert J. Capone, M.D., Elisabeth Curwen, R.N.; Evanston Hospital, Evanston, III. — Gary N. Wilner, M.D., Deborah Hunter-Goldblatt; Geisinger Medical Center, Danville, Pa.—Charles A. Laubach, M.D., Cindy Willier; Greater Baltimore Medical Center, Baltimore — Thaddeus E. Prout, M.D., Roberta H. Franks; Henry Ford Hospital, Detroit — Gerald M. Breneman, M.D., Sharon Baumann, Susan Housholder; Kaiser Foundation Hospital, Portland, Ore. — John A. Grover, M.D., Barbara Brokop, R.N.; Lankenau Hospital, Philadelphia — William L. Holmes, M.D., Delores Dodelin, Ginny Murphy; Long Island Jewish–Hillside Medical Center, New Hyde Park, N.Y. — Kul D. Chadda, M.D., Janet Mascaro, R.N., Jane Smith, R.N.; Maimonides Medical Center, Brooklyn, N.Y. — Edgar Lichstein, M.D., Amy Harrison; Medical College of South Carolina, Charleston—Peter C. Gazes, M.D., Lola Engler; Medical College of Virginia, Richmond—David W. Richardson, M.D., Hannah Overton; Miami Heart Institute, Miami, Fla. — Frank L. Canosa, M.D., Garcia Garrison. R.N.; Montreal Heart Institute, Montreal, Canada — Pierre A. Theroux, M.D., Doris Morissette; Mt. Sinai Hospital, Minneapolis — Philip J. Ranheim, M.D., Julie Levin; Northwestern University Medical School, Chicago—Olga M. Haring, M.D., Linda Anderson; Overlook Hospital. Summit, N.J. — John J. Gregory, M.D., Carol Bowerbank, R.N.; Providence Medical Center, Portland, Ore.—Gordon L. Maurice, M.D., Judy Cunningham; Rush–Presbyterian St. Luke's Medical Center, Chicago—James A. Schoenberger, M.D., Trace Remijas, Arline Wilson; Rutgers Medical School, New Brunswick, N.J. — Peter T. Kuo, M.D., Evelyn Urdanoff; State University of New York at Buffalo — Robert M. Kohn, M.D., Mary Bonora; University of California, San Francisco — Mary Anne Warnowicz, D.O., Carolyn Somelofski, R.N., M.S.; University of Rochester School of Medicine, Rochester, N.Y. — Paul N. Yu, M.D., Charlene Roth, R.N., Julie Olijnyk, R.N.; Veterans Administration Hospital, Little Rock, Ark. — Marvin L. Murphy, M.D., Linda Treat, R.N.; and Veterans Administration Hospital, West Roxbury, Mass. — Kevin M. McIntyre, M.D., Patricia Woods, R.N.

Author Affiliations

From the Department of Research and Statistics, Health Insurance Plan of Greater New York. Address reprint requests to Ms. Weinblatt at Health Insurance Plan of Greater New York, 220 W. 58th St., New York, NY 10019.

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