Despite evidence that social support and various aspects after a myocardial infarction (MI), the impact of psychosocial /supportive interventions has not been demonstrated. Further, little is known about the impact of psychosocial variables and/or interventions among female patients. Previous work by the applicants suggested that a one-year post-MI program of monthly telephone monitoring of psychological stress symptoms, coupled with home nursing visits for patients reporting high stress levels, had an impact on one-year cardiac mortality and longterm MI recurrences among men. However, methodological difficulties prevented drawing firm conclusions. A trial which corrects for these difficulties is currently underway involving 948 post-MI patients. However, the budget is too small to study enough patients to assess program impact separately for women and men. This proposal seeks to expand the sample to 1630 including 734 women and 896 men. In addition to assessing program impact separately for the two genders, the proposed research will examine the importance of psychosocial factors in the prognosis of each sex. At the time of discharge from hospital following a documented MI consenting patients will be randomly assigned to treatment and control groups. Control patients will receive usual care from their physicians. In addition to usual care, treatment patients will be phoned monthly and will respond to a standardized index of psychological symptoms of stress. Those with high stress levels will receive home nursing visits to help reduce their stress. Patients in both groups will take part in three interviews: in the hospital, at three months and at one year post-discharge. Interviews will assess depression, anxiety, anger, self-perceived stress, social support, medication compliance, and cardiac risk factors. Salivary cortisol (a physiological indicator of stress) will be assessed on the evening following each interview. Indicators of residual myocardial infarction, ischemia, and arrhythmias will be obtained from hospital charts. Outcome data will be obtained from hospital charts, death certificates and Quebec medicare data, and will be blindly classified by study cardiologists. Data analysis will involve life table and regression techniques. A separate application will be submitted to allow for longterm follow-up.
