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.
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 www.heart.org/supportnetwork, 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 EM, Strait KM, Dreyer RP, 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: http://jaha.ahajournals.org/content/3/5/e001252.full.
Bucholz EM, Rathore SS, 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 HS, Blumenthal JA, Babyak MA, Strauman TJ, Robins C, Sherwood A. 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 HM. Social support and its relationship to morbidity and mortality after acute myocardial infarction: systematic overview. Arch Intern Med. 2004;164:1514-1518.
Burg MM, 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.