Baseline low perceived social support in post-MI patients was associated with a higher risk of death or nonfatal MI compared to patients without LPSS (23% vs 10%; HR 1.74-2.39).
Cohort (n=1,911)
Does low perceived social support increase the risk of death or recurrent MI in post-MI patients, and does psychosocial intervention improve these outcomes?
Baseline low perceived social support is an independent predictor of death and recurrent MI in post-MI patients, and psychosocial intervention effects may depend on baseline support levels.
Effect estimate: HR 1.74-2.39
Absolute Event Rate: 23% vs 10%
Objective: In post hoc analyses, to examine in low perceived social support (LPSS) patients enrolled in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial (n = 1503), the pattern of social support following myocardial infarction (MI), the impact of psychosocial intervention on perceived support, the relationship of perceived support at the time of MI to subsequent death and recurrent MI, and the relationship of change in perceived support 6 months after MI to subsequent mortality. Methods: Partner status (partner, no partner) and score (12 = moderate support) on the ENRICHD Social Support Instrument (ESSI) were used post hoc to define four levels of risk. The resulting 4 LPSS risk groups were compared on baseline characteristics, changes in social support, and medical outcomes to a group of concurrently enrolled acute myocardial infarction patients without depression or LPSS (MI comparison group, n = 408). Effects of treatment assignment on LPSS and death/recurrent MI were also examined. Results: All 4 LPSS risk groups demonstrated improvement in perceived support, regardless of treatment assignment, with a significant treatment effect only seen in the LPSS risk group with no partner and moderate support at baseline. During an average 29-month follow-up, the combined end point of death/nonfatal MI was 10% in the MI comparison group and 23% in the ENRICHD LPSS patients; LPSS conferred a greater risk in unadjusted and adjusted models (HR = 1.74–2.39). Change in ESSI score and/or improvement in perceived social support were not found to predict subsequent mortality. Conclusions: Baseline LPSS predicted death/recurrent MI in the ENRICHD cohort, independent of treatment assignment. Intervention effects indicated a partner surrogacy role for the interventionist and the need for a moderate level of support at baseline for the intervention to be effective. CAD = coronary artery disease; CHD = coronary heart disease; AMI = acute myocardial infarction; MI = myocardial infarction; ENRICHD = Enhancing Recovery in Coronary Heart Disease; LPSS = low perceived social support; ESSI = ENRICHD Social Support Instrument; UC = usual care; INT = intervention; DISH = Diagnostic Interview and Structured Hamilton; ECG = electrocardiogram; BDI = Beck Depression Inventory; HR = hazard ratio; CI = confidence interval.
Burg et al. (Tue,) conducted a cohort in Post-myocardial infarction (n=1,911). Low perceived social support (LPSS) / Psychosocial intervention vs. No LPSS or depression (MI comparison group) was evaluated on Combined end point of death or nonfatal MI (HR 1.74-2.39). Baseline low perceived social support in post-MI patients was associated with a higher risk of death or nonfatal MI compared to patients without LPSS (23% vs 10%; HR 1.74-2.39).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: