The ischemic heart disease life stress monitoring program: Possible therapeutic mechanisms

Abstract

This paper attempts to identify the therapeutic components responsible for the mortality-reducing impact of the Ischemic Heart Disease Life Stress Monitoring Program. Designed to break the link between stress and illness, this one-year intervention program for patients recovering from myocardial infarctions included monthly telephone monitoring of psychological symptoms of stress and home nursing visits for high stress patients. Nursing interventions were individually tailored for each patient and involved a combination of teaching, support and referral strategies. A randomized controlled trial of the program. involving 453 male patients showed that it reduced stress symptoms and cut one-year mortality rates by 50%. These results are considered in the context of the approaches and outcomes of other educational and support programs for cardiac patients. In addition to sample size two factors appear to differentiate the program from other less successful therapies: patient selection for treatment on the basis of stress scores, and individualized treatment. It is also suggested that stress reduction is not the only plausible mechanism for program impact. Increased compliance with beta-blocking medication may also have been involved. In addition to using larger sample sizes future evaluations of cardiac rehabilitation program should be designed to allow the differentiation of these alternate therapeutic mechanisms.

Key Words:

• Stress
• myocardial infarction
• sudden death
• nursing
• compliance
• rehabilitation.