Psychosocial predictors of mortality in the Cardiac Arrhythmia Suppression Trial-1 (CAST-1)
L Gorkin1, E B Schron, M M Brooks
1Institute for Behavioral Medicine, Providence, Rhode Island 02920.
Insights
Psychosocial factors like social support may impact mortality risk in heart patients. However, antiarrhythmic drugs significantly predicted mortality in a major trial, overshadowing psychosocial effects.
Area of Science:
- Cardiology
- Psychosocial Medicine
- Clinical Trials
Background:
- Psychosocial variables are known to influence clinical event recurrence in symptomatic patients.
- The Cardiac Arrhythmia Suppression Trial-1 (CAST-1) investigated the arrhythmia suppression and mortality hypothesis in post-myocardial infarction patients.
Purpose of the Study:
- To prospectively assess the relationship between psychosocial variables (distress, perceived support, social interaction, life stress) and mortality.
- To adjust for disease severity and known coronary heart disease risk factors.
Main Methods:
- Analysis of data from the Cardiac Arrhythmia Suppression Trial-1.
- Multivariate statistical modeling to assess predictors of mortality.
- Stratified analysis comparing drug treatment groups and placebo.
Main Results:
- Encainide and flecainide were identified as potent predictors of mortality.
- Psychosocial variables were significant univariate predictors but not in multivariate models including drug treatment.
- In the placebo group (without antiarrhythmic drugs), perceived social support emerged as a significant multivariate predictor of mortality.
Conclusions:
- Antiarrhythmic drug treatment in CAST-1 strongly predicted mortality, masking psychosocial effects.
- Perceived social support is a significant independent predictor of mortality in post-myocardial infarction patients not receiving suppressive antiarrhythmic drug therapy.
Abstract:
Psychosocial variables predict the recurrence of clinical events in symptomatic patients, controlling for measures of disease severity. The Cardiac Arrhythmia Suppression Trial-1, a pharmacologic test of the arrhythmia suppression and mortality hypothesis among postmyocardial infarction patients, allowed a prospective test of the relationship of distress, perceived support, social interaction, life stress, and other variables, to mortality, adjusting statistically for ejection fraction, arrhythmia rates, and other known risk factors for coronary heart disease. Results indicated that the treatment medications, encainide and flecainide, were powerful predictors of mortality. Although the psychosocial variables were significant as univariate predictors, these variables were not significant as predictors in a multivariate model that included drug treatment. When the data analysis was restricted to patients randomized to placebo, thereby eliminating the antiarrhythmic drug effect, the level of perceived social support was a significant multivariate predictor of mortality, adjusting for measures of disease severity. The adjusted hazards ratio for a 1-point decrease in the perceived support score is equal to 1.46, based on the multivariate model.
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