H Sanne's research while affiliated with University of Gothenburg and other places

The prognostic importance of somatic and psychosocial variables after a first myocardial infarction was studied in 201 consecutive Gothenburg, Sweden men below 61 years of age who had survived a first myocardial infarction between December 1976 and December 1978. The maximum follow-up time was 100 months. The prognostic importance of somatic, social, and psychological variables was related to the endpoints of death, nonfatal reinfarction, and total events. During follow-up, 48 deaths and 37 nonfatal recurrences occurred. Four variables, none of them significantly correlated with each other, were related to risk of an endpoint. Being single increased risk of death (p less than 0.01) and risk of all events (p less than 0.001), whereas an index reflecting infarct size was correlated to risk of death (p less than 0.001). A prognostic index based upon data available at three months after the myocardial infarction (angina pectoris, hypertension, serum aspartate aminotransferase (S-ASAT) maximum, and smoking) was correlated to risk of nonfatal reinfarction (p less than 0.05). Use of sedatives was also related to risk of reinfarction (p less than 0.05) and to risk of total event (p less than 0.05). The probability of death, reinfarction, and total event was estimated within two and five years after the infarction for all combinations of the variables that were related to risk of an endpoint. It was thus demonstrated that the predictive power increased over time and that the somatic and psychosocial variables independently added information.

The prognostic importance of somatic and psychosocial variables after a first myocardial infarction was studied in 201 consecutive Gothenburg, Sweden men below 61 years of age who had survived a first myocardial infarction between December 1976 and December 1978. The maximum follow-up time was 100 months. The prognostic importance of somatic, social, and psychological variables was related to the endpoints of death, nonfatal reinfarction, and total events. During follow-up, 48 deaths and 37 nonfatal recurrences occurred. Four variables, none of them significantly correlated with each other, were related to risk of an endpoint. Being single increased risk of death (p < 0.01) and risk of all events (p < 0.001), whereas an index reflecting infarct size was correlated to risk of death (p<0.001). A prognostic index based upon data available at three months after the myocardial infarction (angina pectoris, hypertension, serum aspartate aminotransferase (S-ASAT) maximum, and smoking) was correlated to risk of nonfatal reinfarction (p < 0.05). Use of sedatives was also related to risk of reinfarction (p<0.05) and to risk of total event (p<0.05). The probability of death, reinfarction, and total event was estimated within two and five years after the infarction for all combinations of the variables that were related to risk of an endpoint. It was thus demonstrated that the predictive power increased over time and that the somatic and psychosocial variables independently added information.

Following a myocardial infarction any residual symptoms are likely to remind the patient of a possible fatal outcome and be detrimental to successful rehabilitation. Negative psychological attitudes need to be identified early. Intervention to improve the mental state should be introduced to restore self-confidence.

Sick-role and attitude towards disease and work two months after a first myocardial infarction (MI) were studied in relation to social, psychological and somatic factors prior to, during and after the MI in 201 consecutive male patients. Questionnaires and a brief interview covered psychological and social data. Somatic data were registered in a standardized medical examination. New concepts were introduced after factor analysis of the psychological variables. Two out of three patients displayed avoidance behaviour. Seventy per cent had restricted their everyday activities. The leisure time was dominated by passivity. Over-protection was frequent. Sick-role behaviour was significantly related to emotional upset, preoccupation with the health and self-reported coronary symptoms while the shortage of relationships to somatic and cardiac factors was notable. The patients attributed the onset of MI to work-related factors. Work dissatisfaction was an aspect of a general negative attitude towards life and was more frequent among patients with emotional symptoms. The psychological care ought to be improved in order to prevent long-term disability.

Psychosocial outcome in terms of mental state, health preoccupation, leisure activity, avoidance behaviour, sexual activity and attitude towards life and the future one year after a myocardial infarction (MI) was studied in 177 consecutive male, able-bodied patients below 61 yr of age with a first MI. Questionnaires and a brief interview covered the psychological and social data while the somatic variables were recorded in a standardized medical examination. Emotional distress, self-reported symptoms, avoidance behaviour, overprotection, pessimism and a diminished sexual activity were frequent, indicating a poor adaptation. These disturbances were apparent two months after the MI and remained stable. Psychological factors were stronger determinants of maladjustment than smoking, angina pectoris and recorded somatic illness. Neither severity of the infarction nor social and demographic factors determined maladjustment. Intervention must take place early and be directed to psychological factors as well as to the cardiac condition.

Emotional reaction, health preoccupation and sexual adjustment two months after a first myocardial infarction (MI) were studied in relation to social, psychological and somatic factors prior to, during and after the MI in 201 consecutive male patients. Psychological and social data were covered by means of questionnaires and a brief interview and somatic data by a standardized medical examination. New concepts were introduced after factor analysis. The degree of preoccupation varied very much and was considered as a reaction to the diagnosis of MI. Seventy-nine percent of the patients complained about fatigue and 65% felt anxious and depressed. Fatigue and nervousness were regarded by the patients as more disabling than cardiac symptoms. Emotional distress was related to a previous history of emotional complaints and to psychological factors and self-reported coronary symptoms but was unrelated to severity of the infarction, medically rated cardiac symptoms, demographic and social data. Sexual maladjustment, mainly due to fear, was frequent and associated with both emotional and somatic variables. Emotional disturbance after MI is considerable and further measures ought to be taken in order to prevent future disability.

The purpose of the trial was to analyze whether supervised physical training could reduce death and nonfatal reinfarction in a nonselected series of postinfarct patients.All patients born in 1913 and later, who were hospitalized for a myocardial infarction during 1968–1970 in Göteborg Sweden, were randomized to a training group (158 patients) and a control group (157 patients). Other treatment was exactly the same and standardized for the two groups. Twenty-seven percent were excluded from training. Training started 3 months after the infarct and was scheduled for three times a week.The training group had higher physical working capacity after 1 yr than the control group. Blood pressure was lower, but there was no differences in blood lipids. During 4 yr of follow-up, 28 patients died in the training group and 35 in the control group. The numbers of nonfatal reinfarcts were 25 and 28, respectively. Within the training group patients adhering to the program had lower mortality than those who did not, but the former also had lower initially predicted risk of dying. A special analysis of patients who attended the training program in comparison to matched controls also showed a lower mortality. No differences in mortality between the training group and the control group were statistically significant, however.