The effect of a psychosocial intervention and quality of life after acute myocardial infarction: the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial.
The effect of a psychosocial intervention and quality of life after acute myocardial infarction: the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial.
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DOI：
10.1097/00008483-200601000-00002
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发表时间：
2006-01-01
期刊：
影响因子：
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通讯作者：
Blumenthal, James A
中科院分区：
文献类型：
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作者：
Mendes de Leon, Carlos F;Czajkowski, Susan M;Blumenthal, James A
目的：研究促进冠心病患者康复(ENRICHD)的临床试验，旨在测试对抑郁或低领悟社会支持的干预是否能降低急性心肌梗死(MI)患者的死亡率和再梗塞。方法：ENRICHD是一项随机对照临床试验，对来自8个临床中心的2481名患者进行了基于认知行为疗法的心理社会干预与常规医疗护理的比较。如果急性心肌梗死患者符合抑郁、低感受社会支持或两者兼而有之的标准，则包括在内。在最初的1296名患者中，在6个月的临床访问中评估了生活质量。结果：SF12-MCS(差异2.2，95%可信区间1.2-3.2)，LSS(差异1.0，95%CI 0.5-1.5)，LOL(差异0.3，95%CI 0.1-0.6)，但在SF12-PCS上不是(差异0.8；95%可信区间=-0.5-2.0)。干预对生活质量结果的影响程度不大。结论：持续时间有限的心理社会干预对心梗后抑郁或缺乏社会支持的患者的生活质量有一定的改善。可能需要更长时间或更大强度的干预才能使这些患者的生活质量得到更实质性的改善。
PURPOSE: The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) clinical trial was designed to test whether intervening on depression or low perceived social support reduces mortality and reinfarction in patients with acute myocardial infarction (MI). This report analyzes the effect of the intervention on quality of life (QOL), which was an important secondary outcome.METHODS: ENRICHD was a randomized controlled clinical trial comparing a psychosocial intervention based on cognitive behavioral therapy to usual medical care in 2,481 patients from 8 clinical centers. Patients with acute MI were included if they met criteria for depression, low perceived social support, or both. QOL was assessed at the 6-month clinic visit in the first 1,296 patients. QOL measures included the Medical Outcomes Study Short Form summary measures of physical functioning (SF12-PCS) and mental functioning (SF12-MCS), a Life Satisfaction Scale (LSS), and a measure of overall QOL based on the ladder of life (LOL) technique.RESULTS: There were significant treatment differences on the SF12-MCS (difference 2.2, 95% confidence interval [CI] 1.2-3.2), the LSS (difference 1.0, 95% CI 0.5-1.5), and the LOL (difference 0.3, 95% CI 0.1-0.6), but not on the SF12-PCS (difference 0.8; 95% CI = -0.5-2.0). Effect sizes for the intervention on QOL outcomes were modest.CONCLUSIONS: Psychosocial interventions of limited duration confer modest QOL benefits in post-MI patients who are depressed or have low perceived social support. Interventions of longer duration or greater intensity may be required to produce more substantial improvements in QOL in these patients.