Myocardial infarction survival: how important are patients' attitudes and adherence behaviors?

Positive attitudes toward and adherence to prescribed medical regimens among patients recovering from initial episodes of myocardial infarction (MI) intuitively have been viewed as beneficial. A cohort of 157 post-MI patients who participated in a cardiac rehabilitation program was tested for compliance with the Health Adherence Scale and Miller Attitude Scale during hospitalization and again six months later. This study reports on follow-up conducted two to five years after initial MI to determine whether patients' attitudes and adherence behaviors had a significant effect on subsequent cardiovascular morbidity and overall mortality after controlling for known risk factors. The data were analyzed using the Cox proportional hazard regression model. Neither positive patient attitudes nor adherence behaviors were associated with a reduced risk of a morbid or fatal event. However, this study found, as have many others, that the known risk factors of alcoholism, widowhood, cigarette smoking, and diabetes were significantly associated with repeat episodes of MI, while the only risk factor associated with mortality was repeat MI. The study suggests that the benefits of positive attitudes and adherence behaviors are outweighed by the influence of existing cardiovascular risk factors. Thus, the prevention of these risk factors remains the primary determinant in the reduction of MI.