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From the Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina (J.B.); Department of Society, Human Development, and Health, Harvard University, Cambridge, Massachusetts (L.B.); Department of Biostatistics, University of North Carolina School of Medicine, Chapel Hill, North Carolina (D.J.C.); NHLBI, Bethesda, Maryland (S.C.); Department of Psychology, University of Miami, Miami, Florida (P.S.); Department of Biostatistics, University of North Carolina School of Medicine, Chapel Hill, North Carolina (M.H.); College of Public Health, University of Arkansas, Little Rock, Arkansas (V.D.); School of Nursing, University of Washington, Seattle Washington (P.M.); Department of Psychiatry, Washington University, St. Louis, Missouri (J.S.); Department of Psychiatry, Stanford University, Palo Alto, California (C.B.T.).
Address correspondence and reprint requests to Matthew M. Burg, PhD, Behavioral Cardiovascular Health and Hypertension, Columbia University School of Medicine, 622 West 168 Street, PH 9–941, New York, NY 10032. E-mail: mb2358{at}columbia.edu
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 = low support; >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.
Key Words: social support • acute coronary syndrome • clinical trials
Abbreviations: 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.
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