Modest treatment yields heartfelt benefits.

Modest treatment yields heartfelt benefits

Educational and counseling efforts aimed at pumping up the physical health of heart attack survivors may benefit from an unassuming maxim: Less is more. A year-long stress-monitoring program for men recovering from heart attacks, relying on monthly telephone interviews and home visits by nurses when necessary, produced substantial reductions in the incidence of subsequent heart attacks, according to a report in the September-October PSYCHOSOMATIC MEDICINE.

Moreover, during the experimental program and for one year after it ended, subsequent attacks were less likely to be fatal in program participants than in recovering heart attack patients receiving only comprehensive yearly medical checkups.

The long-term benefits of the stress-monitoring approach match those reported for more time-consuming and costly measures for heart disease patients, such as intensive counseling to alter Type A behavior, say study directors Nancy Frasure-Smith and Raymond Prince of McGill University in Montreal. What appears crucial, they maintain, is regular emotional support in the months following a heart attack, when recovering patients find stress particularly difficult to handle.

The treatment devised by Frasure-Smith and Prince is "new, exciting and innovative," writes psychologist Lynda H. Powell of Yale University School of Medicine in the same journal. Replications of the Canadian study will indicate whether sweeping educational and Type A counseling programs are "examples of overkill," says Powell, who studies Type A behavior.

The McGill scientists randomly assigned 539 men recovering from heart attacks to either the experimental or control group. A total of 461 agreed to take part in the study, and 405 provided data for a follow-up five years later. Most had suffered only one heart attack before entering the study.

Patients in the experimental group got a phone call once a month for one year from an interviewer who administered a 20-item stress questinnaire. If the patient reported five or more symptoms, or if he temporarily reentered the hospital at some point, a coronary care nurse paid him a visit at home. Nurses did whatever they felt necessary to help relieve stress. Most commonly, they discussed implications of chest pain, shortness of breath and fatigue, as well as focusing on symptoms of anxiety and depression. They also provided information about heart disease and Type A behavior. Each nurse consulted weekly with other nurses, a psychologist, a psychiatrist and the telephone interviewer.

Half the stress-reduction group received visits by a nurse, and these required an average of five to six sessions, each lasting an hour.

One year after the stress-monitoring program ended, 19 men in the control group had died of a heart attack outside of the hospital, compared with nine men in the experimental group. The program apparently helped to decrease the number of sudden deaths from heart attacks, the researchers contend.

An average of four years after the program ended, 60 controls had suffered another heart attack, compared with 43 men in the experimental group.

Although the health advantages for the experimental group are statistically significant, the researchers acknowledge a major drawback to their study. After some of the subjects dropped out of initial random treatment assignments, the control group was left with a larger proportion of men of low social class, as measured by education, occupation and income, than the experimental group. Lower-class patients may have been more reluctant to accept the added burden of participating in the stress-monitoring program, the researchers suggest.