Myocardial infarction: no social support increases mortality.

Clinical bottom line (level 1a)

  1. Patients who had a first myocardial infarction and had social support are less likely to die than those with no social support.
Bucher : Journal of General Internal Medicine 1994; 9: 409-417
Expires March 2003

The study

Systematic review of inception cohorts of
  • Patients: first myocardial infarction
  • Intervention: social support (family, close confidants etc.) compared with no social support
  • Outcome: cardiac death, sudden death or total mortality


    • Articles found in ? using MEDLINE, ? (search terms: coronary heart disease, myocardial infarction, psychosocial factors, social support and social isolation ) and no other searching strategies were employed.

    Selection criteria: as above
    Appraisal criteria: no details given
    Articles excluded if: no complete report of follow-up, not objective outcomes, inadequate adjustment for confounding factors, inadequate randomisation in intervention studies

    Nine cohorts involving 10, 454 patients were included.
    • Indicator of social support varied between studies.

    The evidence

    • Five out of nine of the cohorts showed that no social support increased the risk of death.
    • Relative risks for the five cohorts ranged between 1.47 to 5.62.
    • The studies showed that the increased risk of death with no social support was increased more for men than women.
    • Two intervention studies (RCTs) demonstrate reduced mortality with community interventions (RR~0.5 for sudden death rates)

    Comments

    1. The results of the nine cohorts were not combined to give an overall relative risk.

    Citation

    1. Bucher HC, : Social support and prognosis following first myocardial infarction. Journal of General Internal Medicine 1994; 9: 409-417
    Contributor: Clare Wotton and Bob Phillips, February 2000
    Reviewer:

    Clinical Question.
    Patient myocardial infarction
    Intervention or Exposure presence of social support
    Comparison absence of social support
    Outcome mortality