Sudden cardiac death (SCD) is one of the major public health problems facing western society, and it is the leading cause of mortality in the U.S. This proposal constitutes an independent project complimentary to the ongoing NIH clinical trial """"""""Cardiac Arrhythmia Suppression Trial (CAST)"""""""". The CAST protocol is designed to examine the effectiveness of antiarrhythmic drug therapy at improving survival among post-myocardial infarction patients with ventricular arrhythmias. This proposal is designed to examine the contributions of social psychological, and behavioral factors to survival in these patients. A number of social and psychological variables have been related to morbidity or mortality from cardiovascular diseases. The independent contributions and interrelationships among these psychosocial and physiological risk factors for SCD mortality will be examined. It is assumed that physiological status will be more strongly related to survival than psychosocial variables, but the addition of psychosocial variables will make significant additional contributions to the explanation of length of survival. All patients who are participating in 8 CAST sites (n=800) will be asked to participate in this study. CAST inclusion criteria are designed to limit participation to a population with high risk for SCD but without medical complications which would preclude or complicate drug therapy. Each subject will complete psychosocial questionnaires at baseline and every 4 months during follow-up visits for two years. This study will provide the basis for identification of a subgroup of post myocardial infarction patients whose psychosocial status promotes susceptibility to SCD. Nurses play a major therapeutic role in the identification and management of these patients and can provide the interventions necessary to improve survival.
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