Influence of Psychosocial Factors and Biopsychosocial Interventions on Outcomes after Myocardial Infarction

Abstract

Management of the myocardial infarction patient may extend beyond the physiologic to include psychosocial factors that may adversely affect cardiac health. Psychosocial factors such as depression, coronary-prone behavior, hostility, social isolation, anxiety, anger, and stress are related to increased cardiac death and illness. Various interventions including cognitive-behavioral therapies, techniques that elicit the relaxation response, meditation, exercise, and increasing social networks, may play a role in improving health outcomes. This article explores the relationship of these psychosocial factors to cardiac health and proposes a biopsychosocial model of care.

In Sickness and in Health: a Literature Review about Function of Social Support within Anxiety and Heart Disease Association

“…Also indirect mechanisms may affect health through unhealthy lifestyles [7] and maladaptive coping behaviors (such as cigarette smoking, proper diet, adherence to medication, adequate physical activity) [30]. Evidence suggests that maladaptive behaviors and lifestyle are in turn associated with increased cardiac disease incidence and developments [31]. Moreover, patients who are too anxious frequently are unable to learn or act upon new information about necessary life-style changes [32].…”

A cross-sectional examination of changes in anxiety early after acute myocardial infarction

“…Although the exact mechanism is not known, it is thought that severe or untreated anxiety activates the sympathetic nervous system and hypothalamus-pituitaryadrenal axis and contributes to recurrent cardiac events. [10][11][12][13] Moser and Dracup 5 reported that patients with AMI and high anxiety had a higher incidence of lethal ventricular dysrhythmias, myocardial ischemia, and reinfarction during their hospital stays. Other investigators concluded that high anxiety after AMI predicts 3-month survival, 14 recurrent cardiac events within the first year, 15 functional status at 1 year, 16 and adverse cardiac events and mortality within 6 to 10 years after AMI.…”

Relaxation: A Self-Care Healing Modality Reduces Harmful Effects of Anxiety

“…The psychological pathway elevates negative mood states, whereas the social-behavioral pathway promotes disconnection from self and others and stress inhibition with resultant unhealthy lifestyle behaviors. 3,4 The deleterious effects of this psychophysiological stress response are troublesome because anxiety is an independent predictor of arrhythmic/ischemic complications and increased mortality in cardiac patients. 4 As part of autonomous nursing practice, relaxation is an integrative therapy that calms the mind and body by reducing sympathetic nervous system activity.…”