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European Heart Journal 1994 15(12):1611-1615;
Copyright © 1994 by the European Society of Cardiology.
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© 1994 The European Society of Cardiology

Long-term prognosis of low-risk, post-MI patients: the importance of subjective perception of disease

D. BAR-ON*,, H. GILUTZ{dagger}, T. MAYMON{dagger}, E. ZILBERMAN{dagger} and N. CRISTAL{dagger}

*Department of Behavioural Sciences, Soroka Hospital, Ben Gurion University of the Negev Beer Sheva, Israel
{dagger}Coronary Intensive Care Unit, Soroka Hospital, Ben Gurion University of the Negev Beer Sheva, Israel

Received 2 December 1993; revised 30 May 1994; .

Correspondence Professor Dan Bar-On, Department of Behavioural Sciences, Ben Gurion University of the Negev, P.O. Box 653, Beer Sheva S4105, Israel

Abstract

In 1980, 87 male patients (age range 34–60 years), hospitalized after their first myocardial infarction (MI), were asked why they believed they got the infarct and what would help them cope with it. In a multiple regression analysis, their causal attributions accounted for 15% of the explained variance in their physical, sexual, social and work functioning after 6 and 18 months, their level of education accounted for 25% and the severity of their infarct for 10%. This result was replicated in a cross-cultural study. A follow-up study shows that 12 years after the MI, the patients' initial causal attributions still accounted for part of their reliabilitation and life expectancy. Of the original 87, 23 had died between 1980–1992 from cardiac causes and 50 male patients were located and re-interviewed at the Soroka ICCU, in 1992. This suggests a very low-risk post-MI sample. The only risk-factor, accounting for the difference between the surviving and the deceased patients, was the initial obesity of the latter. The functional capacity outcome of the survivors was accounted for by their age (24%) and initial causal attributions (26%). Also the initial causal attributions (5%) still accounted for the subjective perception of functioning among the survivors. These results suggest that the initial causal attributions may have created positive or negative self-fulfilling prophecies which liad long-term consequences, especially in a low-risk, post-MI population, in which risk factors hardly effected long-term prognosis.

Key Words: Low risk • myocardial infarction • long-term prognosis • causal attribution


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