Predictors of mortality in female cardiac patients

Investigators
Dr Barbara Murphy, Dr Marian Worcester, Ms Michelle Rogerson, Dr Peter Elliott, Ms Rosemary Higgins,  Heart Research Centre.

Background

Cardiovascular disease is the leading cause of death in women, both in Australia and elsewhere. Mortality and morbidity outcomes from heart attack and coronary artery bypass graft surgery are generally poorer in women than in men, with higher death rates, more recurrent episodes and more frequent readmissions to hospital. Despite this pattern, there has been a lack of focused research into outcomes of acute cardiac events in women. In most studies, males predominate because they represent between 70-80% of cardiac admissions. Because of the smaller number of women in studies, it has been difficult to draw meaningful conclusions about the processes and patterns of their recovery.

We are currently conducting a long-term study of 241 women who were originally studied 12 years ago by the same team of researchers. The baseline study was supported by a grant from the Commonwealth Department of Health and Ageing under the National Health Goals and Targets Program for improving cardiovascular health. The original study was longitudinal, involving four assessments over a 12 month period.  On each occasion comprehensive interviews were carried out and self-report questionnaires were administered to the women who were recruited from the Royal Melbourne Hospital, MelbournePrivate Hospital and Western Hospital.

Aim

The primary objective of this new project is to investigate the relationship between baseline psychosocial factors (anxiety, depression and social isolation) and 12 year mortality in a consecutive series of female patients after heart attack or coronary artery bypass graft surgery.

Methods

We will establish the deaths of most women, together with their cause of death, by consulting the Australian National Death Index (ANDI). Most of those not listed in ANDI should be successfully tracked by consulting the medical records of the hospitals involved and the treating doctors. Research Fellow, Ms Michelle Rogerson, is tracking the women in this study.

The original database offers a unique opportunity to investigate the long-term impact upon mortality of anxiety, depression and social isolation in these women. Specifically, we plan to analyse several psychosocial variables as potential predictors of death. Further, we will investigate the relative importance upon long-term outcomes of marital status, living alone, lack of a close confidant and other indicators of social support and isolation.

Significance of project

There are a number of features of our study which take it beyond previous research in this area. It is one of the first to investigate mortality outcomes in a relatively large sample of women, including both heart attack and coronary artery bypass graft surgery patients. Further, our data permit an investigation of the importance of mild depression, which is common among cardiac patients during convalescence after an acute illness. Previous studies have tended to focus on more severe levels of depression or major depressive illness. If mild depression is shown to have an adverse impact on mortality, then early identification of mildly depressed patients will become especially important, enabling early intervention by general practitioners and other health professionals.

Funding: Funding is currently being sought for this study