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Biomedical subjects

T D Miller

Publications and source records attributed to T D Miller.

At least 37 records · Page 2Linked to original sources
PubMed1998

Usefulness of technetium-99m sestamibi infarct size in predicting posthospital mortality following acute myocardial infarction.

In this multicenter study, 249 patients who underwent tomographic technetium-99m sestamibi infarct size measurement at hospital discharge were followed up for a median duration of 7 months. Infarct size was significantly associated with mortality (chi-square = 5.8, p = 0.02) and could stratify patients into lower and higher risk subsets: 1-year mortality 2% for infarct size < 14% versus 8% for infarct size > or = 14% of the left ventricle.

Aged↗
PubMed1998

Correlation of resting first-pass left ventricular ejection fraction and resting myocardial infarct size.

This study determined the correlation between the extent of the resting perfusion defect by technetium-99m sestamibi tomographic imaging and the first-pass left ventricular (LV) ejection fraction (EF). A total of 1,955 patients underwent technetium-99m sestamibi tomographic imaging with measurement of first-pass resting LVEF. Twenty-five percent of patients had a prior history of myocardial infarction. First-pass LVEF was measured using a peripheral intravenous injection and a multicrystal gamma camera with standard software. Resting tomographic perfusion defect size (infarct size) was quantitated using previously published methods. Mean LVEF for the study group was 0.60 +/- 0.11. Mean LV infarct size was 5 +/- 11%. For the 1,265 patients (65% of the study group) with no measurable perfusion defect, the prevalence of a normal (> or = 0.50) LVEF was 96% (1,212 of 1,265 patients). For patients with a measurable defect (n = 690, 35%), the inverse linear correlation with LVEF was highly significant (r = -0.60, p <0.0001) but with wide confidence limits (SEE = 10 LVEF points), thereby limiting the predictive value in individual patients. Thus, in the absence of known cardiomyopathy, valvular heart disease, or left bundle branch block, patients without a quantifiable resting perfusion defect are highly likely to have a normal resting LVEF and may not require determination of LV function. For patients with resting perfusion defects, LVEF cannot be predicted with confidence and should therefore be measured.

Aged↗
PubMed1998

Prognostic value of vasodilator myocardial perfusion imaging in patients with left bundle-branch block.

BACKGROUND: The prognostic value of tomographic myocardial perfusion imaging with dipyridamole or adenosine in patients with left bundle-branch block has not been established. METHODS AND RESULTS: The study group consisted of 245 patients with left bundle-branch block who underwent tomographic (single photon emission tomography) myocardial perfusion imaging with thallium-201 (n=173) or technetium-99m sestamibi (n=72) and either dipyridamole (n=153) or adenosine (n=92) stress. Patients were prospectively classified into two groups. Patients were classified as "high risk" if they had (1) a large severe fixed defect (n=28), (2) a large reversible defect (n=36), or (3) cardiac enlargement and either increased pulmonary uptake (thallium) or a decreased resting ejection fraction (sestamibi) (n=20). The remaining 161 patients (66% of the study group) were at "low risk." Follow-up was 99% complete at 3+/-1.4 years. Three-year overall survival was 57% in the high-risk group compared with 87% in the low-risk group (P<.0001). Survival free of cardiac death/nonfatal myocardial infarction/cardiac transplantation was 55% in the high-risk group and 93% in the low-risk group (P<.0001). The presence of a high-risk scan had significant incremental prognostic value after adjustment for age, sex, diabetes, and previous myocardial infarction (P<.0001). Patients with a low-risk scan had an overall survival that was not significantly different from that of a US age-matched population (P=.86). CONCLUSIONS: Tomographic myocardial perfusion imaging with adenosine or dipyridamole stress provides important prognostic information in patients with left bundle-branch block, which is incremental to clinical assessment.

Adenosine↗
PubMed1998

Prognostic value of exercise thallium-201 imaging performed within 2 years of coronary artery bypass graft surgery.

OBJECTIVES: We sought to determine the prognostic capabilities of exercise thallium (Tl)-201 tomographic imaging performed relatively early (within 2 years) after coronary artery bypass graft surgery (CABG). BACKGROUND: Exercise testing is commonly performed after CABG, but few data exist demonstrating its prognostic value in this setting. METHODS: Four hundred eleven patients were followed up for a median duration of 5.8 years. Eleven prospectively chosen clinical, exercise and Tl-201 variables were tested for their associations with outcome end points by means of proportional hazards regression models. RESULTS: During follow-up there were 60 deaths from any cause, 53 initial cardiac deaths or nonfatal myocardial infarctions (MIs) and 22 late (>3 months after the Tl-201 study) revascularization procedures. The number of abnormal Tl-201 segments on the postexercise image was the only variable in the multivariate analyses to show a significant association with all three outcome end points: chi-square 7.3, p = 0.007 for overall mortality; chi-square 8.1, p = 0.004 for cardiac death or MI; chi-square 7.8, p = 0.005 for any cardiac event. Other independent predictors of outcome were exercise duration (chi-square 10.7, p = 0.001) and age (chi-square 3.9, p = 0.049) for overall mortality and exercise angina score (chi-square 8.7, p = 0.003) for cardiac death or MI. The 5-year survival rate free of cardiac death or MI was 93% for patients without angina and a normal image or small postexercise perfusion defect versus 71% for patients with angina and a medium or large defect. CONCLUSIONS: Exercise Tl-201 imaging performed within 2 years of CABG can stratify patients into low and high risk subgroups.

Aged↗
PubMed1998

Prognostic value of exercise thallium-201 imaging in a community population.

BACKGROUND: The prognostic value of exercise thallium-201 imaging has been well established in referral patient populations at tertiary care centers, but these results may be influenced by referral bias. METHODS: This study was performed to evaluate the prognostic value of thallium imaging in a community-based population of 446 residents of Olmsted County, Minn. Eleven variables were prospectively selected and tested for their associations with outcome end points. RESULTS: Four variables (age, history of myocardial infarction, number of abnormal thallium segments on the postexercise images, and increased thallium lung uptake) contained the most independent prognostic information. For the end point overall mortality rate, the multivariate chi-square values were 17.2 (p < 0.0001) for age and 20.9 (p < 0.0001) for the number of abnormal thallium segments on the postexercise images. Five-year survival rate for patients older than the median age of 59 years with an abnormal scan was 84% versus 97% for patients < or = 59 years of age with a normal scan. CONCLUSION: Exercise thallium imaging was useful for prognostic purposes in this relatively low-risk community population, confirming the findings of referral population studies.

Adult↗
PubMed1998

Prevalence of spontaneous reperfusion and associated myocardial salvage in patients with acute myocardial infarction.

This study sought to determine the prevalence of spontaneous reperfusion of an infarct-related artery (IRA) and associated myocardial salvage in the absence of thrombolysis or angioplasty. Twenty-one patients with acute myocardial infarction received only heparin and aspirin. At a median of 18 hours after presentation, 12 patients (57%) had angiographic patency of the IRA. Technetium-99m sestamibi was injected acutely on presentation and again at hospital discharge. Acute and final perfusion defect sizes were measured. Their difference, myocardial salvage, was calculated along with salvage index (myocardial salvage/acute defect). Comparing patients with a patent versus occluded IRA, myocardium at risk was similar (16% +/- 12% vs 12% +/- 9% left ventricle, p = NS); however, myocardial salvage (9% +/- 9% vs -2% +/- 7% left ventricle, p = 0.01), and salvage index (0.62 +/- 0.37 vs 0.19 +/- 0.33, p = 0.01) were greater in patients with spontaneous reperfusion. Resolution of chest pain was greater in patients with a patent IRA (100% vs 55%, p = 0.003). Spontaneous reperfusion of the IRA occurs frequently in patients with acute myocardial infarction and is associated with significant myocardial salvage.

Aged↗
PubMed1998

Gender differences in use of stress testing and coronary heart disease mortality: a population-based study in Olmsted County, Minnesota.

OBJECTIVES: We sought to examine the utilization of exercise stress testing in relation to age and gender in a population-based setting. BACKGROUND: The utilization of noninvasive procedures has been shown to be associated with the subsequent use of invasive procedures. Yet, there are no population-based data on the utilization of stress testing; in particular, although gender differences in the use of invasive procedures have been reported, the use of noninvasive procedures has not been examined in relation to gender. METHODS: In Olmsted County, Minnesota, passive surveillance of the medical care of the community is provided through the Rochester Epidemiology Project. A population-based cohort of Olmsted County residents undergoing exercise tests was identified. The medical records of residents with prevalent and incident exercise tests in 1987 and 1988 were reviewed. For persons with an initial test (incidence cohort), data on clinical presentation, test indications and results were abstracted. Stress test utilization rates were calculated, and crude rates were directly adjusted to the age distribution of the 1980 U.S. population. To help interpret patterns of use at the population level, coronary heart disease mortality rates (International Classification of Diseases, 9th revision, codes 410 to 414) were calculated (crude and directly adjusted to the overall age distribution of the 1980 U.S. population) and used as an indicator of coronary disease burden. RESULTS: A total of 2,624 tests were performed. The crude utilization rate (per 100,000) was 1,888 for men and 703 for women (rate ratio for men over women 2.7, 95% confidence interval [CI] 2.5 to 2.9); it remained significantly higher in men across all age strata. The crude incidence rate (per 100,000) of initial stress tests was 1,112 for men and 517 for women (rate ratio 2.2, 95% CI 1.9 to 2.4). For both men and women, the incidence increased with age; however, incidence remained lower in women in all age strata. At the time that they underwent an initial test, women were more symptomatic and had poorer exercise performance than men. The rate ratio of men over women for coronary heart disease mortality was 1.1 (95% CI 0.9 to 1.2). The age-adjusted rate ratios for stress test utilization were 2.8 (95% CI 2.5 to 3.0), and that for coronary heart disease mortality was 1.9 (95% CI 1.7 to 2.2). CONCLUSIONS: These population-based data show that during the study period, the utilization of stress testing in Olmsted County was lower in women than in men. Women in the incidence cohort were older and more symptomatic and had poorer exercise performance than men. Such differences should be considered when examining the utilization of subsequent invasive procedures according to gender.

Adult↗
PubMed1998

Exercise and coronary artery disease prevention.

Physical exercise has become universally accepted as an important component in the primary prevention of coronary disease and in the management of subjects with established coronary artery disease. Exercise should be utilized appropriately for each individual's needs and done in concert with aggressive modification of other risk factors such as abnormal blood lipids, high blood pressure, obesity and cigarette smoking. Such as approach in the preventive management of coronary artery disease is rewarded by beneficial clinical outcomes and savings in health dollars.

Coronary Disease↗
PubMed1997

Pharmacokinetics of MDL 26479, a novel benzodiazepine inverse agonist, in normal volunteers.

MDL 26479 is a new drug undergoing clinical evaluation for the treatment of depression and for memory loss associated with Alzheimer's disease. As part of a dose tolerance trial, the single- (SD) and multiple-dose (MD) pharmacokinetics of MDL 26479 were evaluated in healthy male volunteers. SDs ranging from 2 to 465 mg, and doses of 30, 60, and 120 mg administered twice daily for 28 d, were examined. Serial blood samples were collected for up to 48 h. Plasma MDL 26479 concentrations were determined by HPLC. Plasma MDL 26479 concentration versus time profiles increased rapidly, followed by multiexponential decline. Time to maximum plasma concentration increased over the 230-fold SD range from 0.5 to 3.8 h. Maximum concentrations and areas under the concentration versus time curves increased disproportionately with dose. Apparent oral clearance estimates decreased from 52.9 to 13.8 Lh-1. MD pharmacokinetic parameters for doses from 30 to 120 mg were consistent with those observed following SD, thus indicating that SD pharmacokinetics are predictive of MD. SD and MD terminal half-life estimates were similar and independent of dose.

Administration, Oral↗
PubMed1997

Exercise and its role in the prevention and rehabilitation of cardiovascular disease.

The purpose of this article is to review the beneficial effects of regular exercise in the primary and secondary prevention of coronary artery disease (CAD). Epidemiologic studies indicate that a physically inactive life-style is associated with twice the risk of developing CAD. The magnitude of risk is similar to that of other modifiable risk factors. Meta-analysis of studies of cardiac rehabilitation after myocardial infarction demonstrate that cardiac rehabilitation participants lower their risk of death by 20% to 25% compared to controls. Exercise training results in several beneficial physiological changes including an increase in exercise endurance, higher resting and exercise stroke volumes, lower resting and submaximal exercise heart rates, and increased capillary density and oxidative enzyme capacity in skeletal muscle. In patients with established CAD, exercise training improves symptoms of angina and congestive heart failure and attenuates the severity of exercise-induced ischemia. Regular exercise can favorably modify other risk factors, but the benefits are modest. Reductions in systolic and diastolic blood pressure readings average 6 to 9 mm Hg; decreases in total and low-density lipoprotein (LDL) cholesterol approximate 5 to 10 mg/dL; and increases in high-density lipoprotein (HDL) cholesterol approximate 2 mg/dL. Exercise training as a sole intervention does not appear to enhance smoking cessation. Regular exercise does improve psychosocial well-being. Most studies of physical activity have enrolled predominantly middle-aged men; however, available evidence suggests similar cardiovascular benefits for women, the elderly, and children and youth. Physical activity levels decrease substantially during the school-age-adolescent transition in both males and females. More than half of the adult population is sedentary or inactive. Collectively, accumulated data suggest the need for both individualized/high-risk and population-based approaches to increasing physical activity across the life span.

Adult↗
PubMed1997

Quantitative measures of regional asynergy add independent prognostic information to left ventricular ejection fraction in patients with prior myocardial infarction.

The purpose of this study was to determine if quantitative measurements of regional asynergy add independent prognostic information to global ejection fraction in patients with chronic coronary artery disease. Four hundred eighty-six patients with a history of Q-wave myocardial infarction who underwent gated-equilibrium radionuclide angiography at least 3 months after infarction were monitored for a median duration of 4.7 years. During follow-up there were 95 deaths. Four of five regional asynergy indexes analyzed were associated with overall mortality. The strength of the association between overall mortality and the index that proved to be optimal (univariate chi2 = 26.4, p < 0.001) was stronger than for global ejection fraction (univariate chi2 = 21.5, p < 0.001). For patients with global ejection fraction <40%, 4-year survival was 87% for those with a low asynergy index versus 65% for those with a high asynergy index (p = 0.016). In conclusion, indexes of regional asynergy add independent prognostic information to global left ventricular ejection fraction.

Analysis of Variance↗
PubMed1997

Worsening left ventricular performance on serial exercise radionuclide angiography does not identify high-risk patients.

OBJECTIVE: To determine whether worsening exercise performance on serial exercise radionuclide angiography identifies patients at increased risk of future cardiac events. MATERIAL AND METHODS: One hundred nine medically treated patients with previous Q-wave myocardial infarction underwent two exercise radionuclide angiographic studies at least 6 months apart (median, 16 months) without an intervening clinical event. Worsening exercise performance between the two studies was defined by five criteria: (1) lower (5% or more) peak exercise ejection fraction; (2) worsening peak exercise wall motion score; (3) combination of criteria 1 and 2; (4) worsening serial delta (exercise - rest) ejection fraction; or (5) increasing exercise ST-segment depression of 1 mm or more. Patients were followed up for a median duration of 3.9 years after the second exercise study. RESULTS: Five cardiac deaths and 10 nonfatal myocardial infarctions occurred during follow-up. A Cox proportional hazards analysis failed to show an association between any of the aforementioned variables and cardiac events. Of the 15 patients with cardiac events, 4 (27%) had a lower (5% or more) exercise ejection fraction and 2 (13%) had a worsening exercise wall motion score. Of the 94 patients without cardiac events, 37 (39%) had a lower (5% or more) exercise ejection fraction and 28 (30%) had a worsening serial exercise wall motion score (not a statistically significant difference). CONCLUSION: Worsening exercise performance on serial exercise radionuclide angiography does not identify patients at increased risk of future cardiac events.

Aged↗
PubMed1997

Prospective identification of myocardial stunning using technetium-99m sestamibi-based measurements of infarct size.

OBJECTIVES: We sought to prospectively identify patients with stunning and hyperkinesia at hospital discharge on the basis of mismatches between left ventricular (LV) function and infarct size as assessed by technetium-99m (Tc-99m) sestamibi perfusion tomographic imaging. BACKGROUND: Mechanical indexes of LV function may not accurately reflect myocardial damage after acute myocardial infarction (MI) because of myocardial stunning and compensatory hyperkinesia in noninfarct-related territories. Myocardial perfusion techniques are unaffected by these variables. METHODS: Eighty-four patients with acute MI underwent hospital admission and discharge Tc-99m-sestamibi tomographic imaging. Global LV ejection fraction (LVEF) was measured at hospital discharge and 6 weeks later. The perfusion defect size was quantified and expressed as a percentage of the LV. The discharge perfusion defect, which is a measure of infarct size, was used to predict the 6-week LVEF for each patient based on a previously reported regression equation. Patients were classified into one of three groups depending on whether their LVEF at hospital discharge fell within, above or below one standard error (6.8 LVEF points) of the predicted 6-week LVEF. RESULTS: There were 48 patients classified as having a "match" between function and infarct size; these patients demonstrated no significant change in LVEF at 6 weeks. There were 21 patients (25%) classified as "mismatch stunned" who had discharge LVEFs lower than those predicted by infarct size. These patients demonstrated a significant improvement in mean LVEF at 6 weeks (mean [+/-SD] discharge LVEF 0.41 +/- 0.08, 6-week LVEF 0.47 +/- 0.10; p = 0.003). Fifteen patients (18%) were classified as "mismatch-hyperkinetic." The mean LVEF for these patients significantly declined at 6 weeks (discharge LVEF 0.64 +/- 0.06, 6-week LVEF 0.58 +/- 0.09; p = 0.002). There was a marked increase in LVEF within the infarct zone (8 +/- 15 LVEF points; p = 0.03) for patients predicted to have stunning and a marked decline in LVEF outside the infarct zone (9 +/- 15 LVEF points; p = 0.06) in patients predicted to have hyperkinesia. Both discharge LVEF (p < 0.0001) and group classification (p = 0.005) were independent predictors of LVEF 6 weeks later. CONCLUSIONS: Perfusion imaging with Tc-99m-sestamibi can identify post-MI patients at hospital discharge in whom LV function is discordant with the measured infarct size. Patients with stunning have late increases in LVEF; patients with hyperkinesia have late decreases. This methodology, performed at discharge, is predictive of late changes in LV function.

Aged↗
PubMed1996

Peak exercise blood pressure stratified by age and gender in apparently healthy subjects.

OBJECTIVE: To determine the peak blood pressure responses during symptom-limited exercise in a large sample of apparently healthy subjects, including both men and women over a wide range of ages. DESIGN: We retrospectively studied the blood pressure response during maximal treadmill exercise testing with use of the Bruce protocol in apparently healthy subjects. MATERIAL AND METHODS: Peak exercise blood pressures in 7,863 male and 2,406 female apparently healthy subjects who underwent a screening treadmill exercise test with the Bruce protocol between 1988 and 1992 were analyzed by age and gender. RESULTS: In this large referral population of apparently healthy subjects, peak exercise systolic and diastolic blood pressures and delta systolic blood pressure (rest to peak exercise) were higher in men than in women and were positively associated with age. In men, the 90th percentile of systolic blood pressure increased from 210 mm Hg for the age decade 20 to 29 years to 234 mm Hg for ages 70 to 79 years; the corresponding increase among women was from 180 mm Hg to 220 mm Hg. Delta diastolic blood pressure also increased with advancing age. The difference in peak and delta systolic blood pressures between men and women seemed to decrease after age 40 to 49 years. Exercise hypotension, defined as peak exercise systolic pressure less than rest systolic pressure, occurred in 0.23% of men and 1.45% of women and was not significantly related to age. CONCLUSION: Overall, peak exercise systolic and diastolic, as well as delta systolic, blood pressures were higher in men than in women and increased with advancing age. The reported data will enable clinicians to interpret more accurately the significance of peak exercise blood pressure response in a subject of a specific age and gender and will allow investigators to define exercise hypertension in statistical terms stratified by age and gender.

Adult↗
PubMed1995

Infarct size after acute myocardial infarction measured by quantitative tomographic 99mTc sestamibi imaging predicts subsequent mortality.

BACKGROUND: 99mTc sestamibi is a recently developed radioisotope that has been used to measure myocardium at risk and infarct size. The relation between these measurements and subsequent patient outcome has not yet been demonstrated. METHODS AND RESULTS: Two hundred seventy-four consecutive patients with acute myocardial infarction underwent tomographic 99mTc sestamibi imaging on arrival at the hospital (to measure myocardium at risk before reperfusion therapy) and at hospital discharge (to measure the amount of salvaged myocardium and final infarct size). Defect size on the sestamibi images was quantified using a threshold value of 60% of peak counts from the circumferential count profile curves generated for five representative slices of the left ventricle. Patients were followed after hospital discharge to evaluate the association between final infarct size and subsequent mortality. The median defect size measured was 27% of the left ventricle at presentation to the hospital (range, 0% to 77%) and was 12% of the left ventricle at hospital discharge (range, 0% to 68%). Almost one half of the patients had a final infarct size of < or = 10%. The median amount of myocardium salvaged was 9% (range, -31% to 75%). During a median duration of follow-up of 12 months, there were 10 deaths (7 cardiac and 3 noncardiac) and 1 resuscitated out-of-hospital cardiac arrest. There was a significant association between infarct size and overall mortality (chi 2 = 8.66, P = .003) and cardiac mortality (chi 2 = 11.89, P < .001). Two-year mortality was 7% for patients whose infarct size was > or = 12% versus 0% for patients whose infarct size was < 12%. There also was a significant association between myocardium at risk and cardiac mortality (chi 2 = 6.87, P = .009). There was no association between myocardium at risk and overall mortality or between amount of myocardium salvaged and either overall mortality or cardiac mortality. CONCLUSIONS: Larger infarct size measured by 99mTc sestamibi imaging after acute myocardial infarction is associated with increased mortality risk during short-term follow-up.

Aged↗
PubMed1995

Limited prognostic value of thallium-201 exercise treadmill testing early after myocardial infarction in patients treated with thrombolysis.

The purpose of this study was to determine the prognostic value of thallium-201 exercise treadmill testing performed early after myocardial infarction in patients treated with thrombolysis. A retrospectively identified group of 210 patients treated with thrombolytic therapy alone (n = 131) or with thrombolytic therapy and coronary angioplasty (n = 79) who underwent tomographic thallium exercise treadmill testing 9 +/- 6 days after infarction were followed up for a median of 21 months. There was a high prevalence of abnormalities on the thallium studies. One hundred thirty-nine (66%) patients had a high-risk scan, defined as redistribution in at least one segment, a defect outside the infarct zone, or increased pulmonary uptake. Thirty-six (17%) patients underwent early revascularization. In the remaining 174 patients, there were 30 initial cardiac events (1 cardiac death, 11 nonfatal recurrent myocardial infarctions, and 18 revascularization procedures performed > 3 months after the thallium study). No single exercise or thallium variable was predictive of outcome. At 2 years there were no differences in survival free of any cardiac event for patients with a high- or low-risk thallium scan treated with thrombolysis alone (high-risk scan 86% and low-risk scan 80%; p not statistically significant [NS]) or with both thrombolysis and coronary angioplasty (high-risk scan 80% and low-risk scan 77%; p NS). Postinfarction exercise thallium variables associated with poor outcome in the prethrombolytic era were not associated with an adverse outcome in patients who had been treated with thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Medical and economic costs of psychologic distress in patients with coronary artery disease.

OBJECTIVE: To determine the effect of psychologic distress, measured with a commonly used screening questionnaire, on 6-month morbidity and rehospitalization costs in coronary patients. DESIGN: Psychologic distress was determined by screening with the Symptom Checklist-90--Revised (SCL-90-R) self-report inventory during the second week of cardiac rehabilitation. Costs associated with cardiovascular rehospitalization during a 6-month follow-up period were recorded, and differences between "distressed" and "nondistressed" patients were analyzed statistically. MATERIAL AND METHODS: The study cohort consisted of 381 patients (311 men and 70 women) referred for cardiac rehabilitation after an index hospitalization for unstable angina, myocardial infarction, coronary angioplasty, or coronary bypass procedure. Patients with SCL-90-R scores above the 90th percentile for outpatient adults were considered distressed (N = 41); patients with scores below this level were considered nondistressed (N = 340). RESULTS: The 6-month follow-up was complete in all but 1 of the 381 patients. Distressed patients had significantly higher rates of cardiovascular rehospitalization, any recurrent events, and recurrent "hard events" (cardiac death, myocardial infarction, or cardiac arrest and resuscitation) within 6 months after dismissal from their index hospitalization in comparison with nondistressed patients. Adjustment for other factors associated with a risk of early rehospitalization and recurrent events did not reduce the strength or significance of the association between psychologic distress and early cardiovascular rehospitalization or recurrent events. The mean rehospitalization costs were significantly higher in the distressed than in the nondistressed patients ($9,504 versus $2,146). CONCLUSION: These data add support to the hypothesis that psychologic distress adversely affects the prognosis in coronary patients, confirm the added morbidity and rehospitalization costs attributable to psychologic distress, and suggest the potential for improving the prognosis in selected coronary patients by identification and appropriate treatment of psychologic distress.

Adaptation, Psychological↗