Role of psychosocial factors in long-term adherence to secondary prevention measures after myocardial infarction: a longitudinal analysis

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) nonsmoking; (4) healthy diet; (5) maintaining recommended body weight. Associations between psychosocial factors and prevention scores 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 to 0.80 (SD, approximate to 0.20). After multivariable adjustment, PSS (beta = 0.087, P = .002, per 1 SD increase) and SOC (beta = 0.082, P = .006, per 1 SD increase) were positively associated with secondary prevention adherence. The prevention score predicted survival over 23-year 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. (C) 2020 Elsevier Inc. All rights reserved.