Prognostic importance and long-term determinants of self-rated health after initial acute myocardial infarction

Background: Self-rated health (SRH) is a valid measure of health and its trajectories over time have been found to predict mortality. A better understanding of the determinants of changes in SRH is required, particularly post-myocardial infarction (MI), where rapid changes in health may occur. Objectives: To evaluate the prognostic importance of SRH and the determinants of its long-term trajectory in patients with MI. Patients and Methods: Between February 1992 and February 1993, 1521 consecutive patients aged ≤65 years (19% women) discharged from all hospitals in central Israel after initial acute MI were enrolled and followed-up for a mean of 12 years. Extensive data were obtained at study entry, with SRH measured at baseline (retrospective assessment of pre-MI health status) and at 5 and 10 years. Results: Baseline SRH showed a strong graded association with mortality post-MI. The association was further strengthened when changes in SRH over time were taken into account. Using generalized estimating equations, independent predictors of poor SRH at follow-up were Asian/African origin, low education, poor income, low baseline SRH, comorbidity, impaired ejection fraction, diabetes, dyslipidemia, obesity, and physical inactivity. In a subsample with available psychosocial measures (n = 668), low social support and sense of coherence and high anxiety and depression were also predictive of poor SRH. Conclusions: SRH is an important risk marker after MI and its long-term trajectory is accurately predicted by demographic, socio-economic, clinical, and psychosocial measures. Monitoring of SRH post-MI is therefore warranted.