CME: Social Support After Acute Myocardial Infarction

CME: Social Support After Acute Myocardial Infarction
Author Information (click to view)

Emily M. Bucholz, MD, PhD, MPH

Boston Children’s Hospital

Emily M. Bucholz, MD, PhD, MPH, has indicated to Physician’s Weekly that she has received an F30 training grant from the National Heart, Lung, and Blood Institute (F30HL120498-01A1).

Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

  1. Review the results of a study that investigated both the physical and mental health consequences of low social support following an acute myocardial infarction among younger patients, particularly women.
  2. Explain how physicians can help improve social support for patients following an acute myocardial infarction.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at

Credit Available(click to view)


CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.


AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)


Keith D’Oria, Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Emily M. Bucholz, MD, PhD, MPH
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.


Emily M. Bucholz, MD, PhD, MPH (click to view)

Emily M. Bucholz, MD, PhD, MPH

Boston Children’s Hospital

Emily M. Bucholz, MD, PhD, MPH, has indicated to Physician’s Weekly that she has received an F30 training grant from the National Heart, Lung, and Blood Institute (F30HL120498-01A1).

Lower social support may increase the risk of poor health outcomes in young patients with acute myocardial infarction (AMI). Efforts to identify non-traditional cardiovascular risk factors like social support may offer important points of intervention after AMI.

Studies have shown that social support is an important prognostic predictor in older people who have suffered an acute myocardial infarction (AMI). Patients with low perceived social support have worse outcomes after their AMI, including higher mortality, more cardiac events, and lower quality of life (QOL). However, most studies have focused on older men, and few analyses have looked at the role of social support in younger AMI patients, especially women.

“Younger AMI survivors are at an entirely different stage of life and often have different social connections and support structures,” says Emily M. Bucholz, MD, PhD MPH. “While older people tend to rely on their immediate family for help, younger individuals are more likely to include fewer family members and more friends and coworkers in their support networks. Younger people may also experience more stress from work, raising their family, or social obligations, which can compromise their support structures. As a result, social support may be a particularly important predictor of AMI prognosis in these patients.”

Examining Younger AMI Patients

In a study published in the Journal of the American Heart Association, Bucholz and colleagues used data from the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study to examine social support in younger patients after they had an AMI, particularly women, from the United States and Spain. VIRGO contains detailed socio-demographic and psychosocial information as well as data on mental health, depression symptoms, and QOL during follow-up.


Data from VIRGO were used to investigate both the physical and mental health consequences of low social support after AMI. The investigators evaluated self-reported social support from 3,432 AMI patients between the ages of 18 and 55. Participants were surveyed during the index hospitalization and at 1 and 12 months after their AMI and then categorized as having low, moderate, or high social support. According to the results, more than 21% of all patients in the study were classified as having low social support, with men and women having comparable social support levels at baseline.

Poorer Outcomes With Less Support

Patients with low social support reported having a lower functional status and QOL and more depressive symptoms at 1 and 12 months after their AMI than patients with moderate or high social support (Figure). “When patients were initially examined after their AMI, those with low social support were more likely to be single, live alone, and be unemployed,” Bucholz says. “They were also more likely to smoke, abuse alcohol, and have other cardio-vascular risk factors, including hypertension, dia-betes, and depression.”

Collectively, results of the study suggest that young patients with low social support have poorer mental health and more depressive symptoms at the time of AMI. This may place these individuals at higher risk of poorer overall health outcomes during the year following their AMI.

Opportunities for Change

Data from the study present an opportunity to consider changes in guiding patients after they suffer an AMI. Bucholz says physicians need to think beyond treatment with just medications and procedures and pay more attention to the support systems that patients have at their disposal. “Physicians should look at how well-connected patients are with others after they suffer an AMI,” she says. “Support networks can have very powerful effects on patient recovery and QOL after an AMI.”

Currently, social support factors are not included in risk models that are used to evaluate patients after an AMI. “Our findings suggest that there may be some utility to identifying patient support networks when patients are first hospitalized for an AMI,” says Bucholz. “We should consider including post-AMI support systems when we attempt to risk stratify patients and make conscious efforts to identify those who could benefit from additional support after they are hospitalized with an AMI.”

The mechanisms by which low social support negatively affects AMI patient outcomes remain unclear and require further investigation, and evaluations on potential interventions for reducing risks are needed. Given the low mortality rate in younger patients with AMI, clinicians may need to focus on outcomes such as health status, depression, and QOL when designing interventions for patients with low social support.

Helpful Resources

Recently, the American Heart Association and American Stroke Association launched their Support Network campaign, an online community intended for people living with heart disease and stroke. Available at, the website offers a venue for people to find and share emotional support from others who are going through similar journeys. Users can share stories, experiences, and practical advice that can positively impact the lives of patients who have suffered an AMI. “This tool can be a valuable resource for younger survivors of AMIs,” Bucholz says. “Clinicians should encourage their patients to participate in the campaign to get the support they need.”

Readings & Resources (click to view)

Bucholz E, Strait K, Dreyer R, et al. Effect of low perceived social support on health outcomes in young patients with acute myocardial infarction: results from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study. J Am Heart Assoc. 2014;3:e001252. Available at:

Bucholz E, Rathore S, Gosch K, et al. Effect of living alone on patient outcomes after hospitalization for acute myocardial infarction. Am J Cardiol. 2011;108:943-948.

Lett H, Blumenthal J, Babyak M, et al. Social support and coronary heart disease: epidemiologic evidence and implications for treatment. Psychosom Med. 2005;67:869-878.

Barth J, Schneider S, von Kanel R. Lack of social support in the etiology and the prognosis of coronary heart disease: a systematic review and metaanalysis. Psychosom Med. 2010;72:229-238.

Mookadam F, Arthur H. Social support and its relationship to morbidity and mortality after acute myocardial infarction: systematic overview. Arch Intern Med. 2004;164:1514-1518.

Burg M, Barefoot J, Berkman L, et al. Low perceived social support and post-myocardial infarction prognosis in the enhancing recovery in coronary heart disease clinical trial: the effects of treatment. Psychosom Med. 2005;67:879-888.

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