LAUSR

PURPOSE Psychosocial factors have been linked to myocardial infarction (MI) outcomes. Whether psychosocial factors affect post MI long-term adherence to secondary prevention recommendations remains uncertain. METHODS Patients ≤65 years (n=616) were assessed for optimism, perceived social support (PSS), sense of coherence (SOC), anxiety and depression at initial hospitalization for acute MI (1992-1993). Adherence to secondary prevention measures was recorded in interviews 3-6 months, 1-2, 5 and 10-13 years after MI. Prevention score (proportion of recommendations met) was developed based on: (1) medication adherence; (2) exercise; (3) non-smoking; (4) healthy diet; (5) maintaining recommended body weight. Associations between psychosocial factors and prevention score were estimated using Generalized Estimating Equation models. The role of the prevention score in long-term survival was assessed using time-dependent Cox regression analysis. RESULTS Average follow-up prevention scores ranged from 0.70-0.80 (SD, ≈0.20). After multivariable adjustment, PSS (β=0.087, P=0.002, per 1 SD increase) and SOC (β=0.082, P=0.006, per 1 SD increase) were positively associated with secondary prevention adherence. The prevention score predicted survival over 23-years follow-up (adjusted hazard ratio=0.79; 95% CI: 0.68-0.91, per 1 SD increase). CONCLUSIONS Psychosocial factors following MI, particularly PSS and SOC, were associated with long-term adherence to secondary prevention measures.