The impact of secondary prevention initiatives on survival in higher-risk socioeconomically
disadvantaged patients after acute myocardial infarction (AMI) may depend on behavioral
adaptive responsiveness, uptake, and adherence to healthier lifestyles. From December
1999 to February 2003, 1,801 patients in Ontario, Canada were interviewed regarding
their lifestyle behaviors at 30 days after their index AMI hospitalization. Data were
obtained using self-reported surveys, medical chart abstraction, and administrative
data linkage. Multivariate analyses were adjusted for baseline sociodemographic, cardiac
risk severity, and co-morbid conditions. Socioeconomically disadvantaged patients
had greater cardiac risk severity at baseline than did their wealthier better-educated
counterparts. Compared with lower-income patients, patients with higher incomes were
less likely to smoke (adjusted odds ratio [OR] for highest vs lowest income tertiles
0.36, 95% confidence interval [CI] 0.21 to 0.63, p <0.001), more likely to participate
in exercise (adjusted OR 1.40, 95% CI 1.07 to 1.85, p = 0.02), and more likely to
decrease or discontinue alcohol use (adjusted OR 1.64, 95% CI 1.16 to 2.34, p = 0.06).
The relation between education and lifestyle behaviors was less pronounced for education
than for income. After adjustment for baseline factors, patients who acknowledged
participation in regular physical exercise at 1 month had a significantly lower long-term
mortality than those who did not. In conclusion, socioeconomically disadvantaged patients
were sicker at baseline and less behaviorally responsive to embarking on healthy lifestyle
changes after AMI than were those of higher socioeconomic status.
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Article Info
Publication History
Published online: October 13, 2008
Accepted:
August 2,
2008
Received in revised form:
August 2,
2008
Received:
June 6,
2008
Footnotes
The Socio-Economic and Acute Myocardial Infarction (SESAMI) study is supported by an operating grant from the Canadian Institutes of Health Research. The SESAMI pilot study was supported by the 1988 Michael Smith Award of Excellence from the Medical Research Council of Canada. The Institute for Clinical Evaluative Sciences is supported in part by a grant from the Ontario Ministry of Health. Dr. Alter is a career investigator with the Heart and Stroke Foundation of Ontario and the chief scientific officer of Intervent Canada (PrevCan), a therapeutic lifestyle and disease-management program; Dr. Gordon is the chief medical and scientific officer of Nationwide Better Health, Savannah, Georgia.
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© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
