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Perceived stress as a risk factor for lower compliance with health-behavior instructions following an acute myocardial infarction
background: The American College of Cardiology and American Heart Association highly recommend patients who have experienced an AMI be advised on multiple risk-management factors at hospital discharge. However, it is unclear why many patients do not follow instructions given at hospital discharge about health behaviors known to promote recovery. We conducted a prospective study among individuals who experienced an AMI to examine whether participants’ stress levels predict poor compliance with discharge instructions over time.
method: Using a prospective cohort design, we assessed adherence to hospital discharge instructions over 12 months among 349 individuals who were hospitalized with AMIs in four major hospitals in Connecticut. Stress was assessed via self-report prior to discharge using the Perceived Stress Scale. Main outcome was self-report adherence to health-behavior discharge instructions on prescribed medication, healthy diet, physical activity, cardiac rehabilitation, and alertness to symptoms at 1 month, 8 months, and 12 months post-discharge. Linear mixed-effects regression model was used with adjustment for demographic and clinical factors.
results: On average, participants reported a failure to adhere to 34.9% of the discharge instructions at any given follow-up time. Participants with higher perceived stress at baseline had lower adherence to discharge instructions (β= -1.957, p<0.001) after adjusting for sociodemographic factors, clinical presentation, and health status. Moderator analysis showed that this relationship did not vary over time, nor did it vary with gender, race or educational level.
conclusion: Perceived stress was found to be a risk factor for lower adherence to health-behavior instructions. This suggests that if health care providers could reduce patients’ stress before giving discharge instructions, it might increase compliance and improve health outcomes. Therefore, stress management programs both during hospital stays and in the community after discharge are worth considering as part of the treatment plan for patients experiencing AMI.
Learning Areas:
EpidemiologyPublic health or related research
Social and behavioral sciences
Learning Objectives:
Analyze how perceived stress predicts patients' compliance with health-behavior instructions upon discharge from the hospital after experiencing an acute myocardial infarction. Identify perceived stress as a potential area to target to improve treatment outcome and long-term survival for patients hospitalized for acute myocardial infarction.
Keyword(s): Adherence, Heart Disease
Qualified on the content I am responsible for because: I have been the lab manager and researcher at Yale School of Public Health Division of Social Behavioral Sciences while working with faculty members on health behavioral epidemiology, including perceived stress among post-acute myocardial infarction patients. One of my scientific interest is to develop strategies to improve long-term health outcomes of patients by targeting health behaviors.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.