Coronary artery disease and behavior modification

Townsend Letter for Doctors and Patients, Feb-March, 2007 by Robert A. Anderson

In this study, 1,013 post-myocardial infarction patients were observed for 4.5 years to determine the possibility that type A coronary-prone behavior could be altered and the effect such alteration might have on subsequent cardiac morbidity and mortality. Of these patients, 592 were randomly assigned to an experimental group, which received both group cardiac education and type A behavioral counseling; 270 were assigned to a control group, which received group cardiac educational counseling only; and 151 to a "comparison group," receiving no group counseling of any kind. Using the "intent-to-treat" principle, marked reduction in type A behavior was observed at the end of 4.5 years in 35.1% of participants given cardiac + type A behavior counseling vs. 9.8% of participants given only cardiac counseling. The cumulative 4.5-year rate of recurrence of cardiac "events" was 12.9%, 21.2%, and 28.2% in the three groups, respectively (p<.005). Significant differences in numbers of cardiac deaths between the experimental and control participants emerged by the end of the study's first year.

Friedman M, et al. Alteration of type A behavior and its effect on cardiac recurrences in post myocardial infarction patients: Summary results of the recurrent coronary prevention project. J Am Heart. 1986 Oct; 112(4):653-65.

COMMENT: Altering type A behavior substantially reduced cardiac morbidity and mortality in post-MI patients. The changes in behavior were significantly greater in those in whom the focus of the counseling included looking at patient behaviors and determining how to modify them. Cardiac education alone had much less impact. Counseled persons can and do change their attitudes, thinking, emotions, and behaviors with fairly brief times of emphasis. Group counseling of this sort is even more effective and efficient. Critics argue that busy practitioners cannot spare the time to include this in their clinical work; looking at the outcomes, it would appear that they must take what time is necessary to improve the outcomes. And other studies show that very little extra time is involved.