[Stress and prevention in the recurrence of coronary heart disease.]

A good deal of recent research suggests that a period of mounting life stress is a precursor of many physical illnesses, including episodes of coronary heart disease (CHD). It should be possible then, by monitoring levels of stress to predict when a high risk individual is likely to suffer a further illness episode, and in some cases to prevent the episode by alleviating stress producing problems. Based on this concept, we have telephone-monitored (at monthly intervals) 37 CHD patients discharged from the coronary unit of the Montreal General Hospital. Stress was measured using a 20-item, self-report scale (Goldberg), and charted for each patient over a seven month period. When a patient's stress rose above a critical level he received a home visit by the project nurse, who investigated his problems and attempted to alleviate them. Interventions varied from simple reassurance to referral for psychiatric treatment or legal aid. Monitoring stress in this way revealed a picture remarkably like the theoretical model. None of the 15 consistently low-scoring patients required rehospitalization. Eleven patients had low scores at the time of discharge, but their scores rose above the critical level in subsequent months. Nine of them responded in a gratifying way- to the home visit and subsequent intervention by the nurse, and none required rehospitalization. The one patient of this type who did require hospitalization had not received a home visit because no nurse was available at the time. Four of the nine patients with consistently high scores required eight rehospitalization s for CHD episodes. These patients seemed to be chronically stressed, and often required continuous support from the nurse. Our study suggests that life stress may be more important than the traditional physical risk factors (obesity, smoking, hypertension, family history of CHD, lack of exercise) in the etiology of recurrent CHD when patients receive adequate medical care. Some of our findings suggest that the nurse's interventions do reduce rehospitalizations, but a large scale controlled study is called for. We conclude that this technique is worth further evaluation, both as a research method and as a practical device for the prevention of rehospitalization of CHD patients and of other types of episodic illnesses.