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Patient Satisfaction With Treatment After Acute Myocardial Infarction: Role of Psychosocial Factors

From the Department of Internal Medicine/Geriatrics (L.C.B.), the Department of Epidemiology and Public Health (J.H.L., H.M.K.), and the Department of Internal Medicine (H.M.K.), Yale University School of Medicine, New Haven, CT; the Department of Medicine (J.A.S., P.G.J.), Mid America Heart Institute, and Univesity of Missouri-Kansas City, MO; the Section of Cardiology (J.S.R., M.E.P.), Denver Veterans Affairs Medical Center, Denver, CO; and the Department of Medicine (V.V., S.P.), Emory University School of Medicine, Atlanta, GA.

Address correspondence and reprint requests to Lisa C. Barry, Program on Aging, Yale University School of Medicine, 300 George Street, Suite 775, New Haven, CT 06511. E-mail: lisa.barry{at}yale.edu

Objective: To determine if psychosocial status influences treatment satisfaction, a quality-of-care indicator, of patients who were hospitalized for acute myocardial infarction (AMI).

Methods: Psychosocial variables (social support, dispositional optimism, and depression) were assessed in 1847 AMI patients who completed a 1-month assessment in Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER), a multicenter, prospective cohort study. Patients' treatment satisfaction was determined using the Treatment Satisfaction scale of the Seattle Angina Questionnaire. The association between psychosocial variables and treatment satisfaction—adjusted for site, sociodemographics, medical history, clinical presentation, and treatment procedures—was evaluated using a censored normal model.

Results: Study participants were primarily white (77.6%) and male (68.8%), with a mean age of 60.6 ± 12.7 (SD) years. Satisfaction with posthospitalization treatment following AMI increased as social support (Wald ² = 35.02, p < .001) and dispositional optimism (ß = 1.42; 95% CI 0.24, 2.60) increased. Participants with mild (–3.10, 95% CI –5.77, –0.44), moderate (–4.77, 95% CI –8.16, –1.38), moderately severe (–8.49, 95% CI –13.47, –3.52), and severe (–11.65, 95% CI –18.77, –4.53) depression had significantly worse treatment satisfaction compared with the nondepressed participants.

Conclusion: Assessing psychosocial variables, such as social support, dispositional optimism, and depression severity before hospital discharge, may indicate who is likely to be more satisfied with posthospitalization cardiac care 1 month following AMI. Without controlling for psychosocial status, treatment satisfaction may be a biased indicator of quality. Future studies should evaluate whether psychosocial intervention after AMI can improve satisfaction.

Key Words: treatment satisfaction • psychosocial • outcomes • myocardial infarction • registry

Abbreviations: ACS = acute coronary syndrome; AMI = acute myocardial infarction; CABG = coronary artery bypass grafting; CI = confidence interval; CPK-MB = creatine phosphokinase-2; ENRICHD = Enhancing Recovery in Coronary Heart Disease; ESSI = ENRICHD Social Support Instrument; IQR = interquartile range; LOT-R = Life Orientation Test-Revised; NSTEMI = non-ST segment elevation myocardial infarction; OR = odds ratio; PCI = percutaneous cardiac intervention; PHQ-9 = Patient Health Questionnaire-9; PREMIER = Prospective Registry Evaluating Myocardial Infarction: Events and Recovery; RR = relative risk; SAQ = Seattle Angina Questionnaire; SAS = Statistical Analysis Systems; SD = standard deviation; TIA = transient ischemic attack; TIMI = thrombolysis in myocardial infarction.