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, ≈0.20). After multivariable adjustment, PSS (β = 0.087, P =.002, per 1 SD increase) and SOC (β = 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.