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Perceived adequacy of tangible social support and health outcomes in patients with coronary artery disease

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Abstract

Objective

Health outcomes of patients with chronic disease might be influenced by assistance from others in performing daily activities. We examined whether perceived adequacy of such tangible support was associated with prognosis in a cohort of patients with coronary artery disease.

Design

Longitudinal cohort study.

Setting/Participants

In spring 1993, a cohort of 1,468 patients with chronic artery disease was identified using claims data. The cohort consisted of all surviving residents of Manitoba. Canada, who had been hospitalized for acute myocardial infarction from 1991 to 1992: 820 patients completed the initial survey, and 734 completed a follow-up survey approximately 1 year later.

Measurements and Main Results

Adequacy of tangible support was assessed by asking if respondents needed help at home because of health problems, and whether these needs were met. We examined the association between perceived adequacy of tangible support and health outcomes at 1 year (mortality, physical function). Of 820 participants, 74% perceived no need for help, 13% has sufficient help, 9% needed more help, and 5% needed much more help; 31 patients died during follow-up. After adjustment for age and initial health status, odds ratios (95% confidence interval) for death were: sufficient help 1.8 (0.61, 5.8); need more help 3.2 (1.1, 9.4); and need much more help 6.5 (2.0, 21.6) compared with respondents with no perceived need. Decline in physical function was also linearly related to perceiving less-adequate tangible support. Sensitivity analyses indicated it is highly improbable that results were due to selection bias.

Conclusions

Perceived lack of needed assistance was related to mortality and to decline in physical functioning. Adequacy of tangible support was an important prognostic factor for these patients with coronary artery disease and may be a determinant of health outcomes.

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Author information

Authors and Affiliations

  1. Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH

    Anna N. A. Tosteson ScD & Elliott S. Fisher MD, MPH

  2. Department of Medicine, Dartmouth Medical School, Hanover, NH

    Anna N. A. Tosteson ScD, Chiang Hua Chang MS & Elliott S. Fisher MD, MPH

  3. University of Manitoba, Winnipeg

    Brock Wright MD & Joy Plohman RN, MBA

  4. VA Outcomes Group (111B), Department of Veterans Affairs Medical Center, 05009, White River Junction, VT

    Steven Woloshin MD, MS, Lisa M. Schwartz MD, MS & Elliott S. Fisher MD, MPH

Authors
  1. Steven Woloshin MD, MS
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  2. Lisa M. Schwartz MD, MS
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  3. Anna N. A. Tosteson ScD
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  4. Chiang Hua Chang MS
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  5. Brock Wright MD
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  6. Joy Plohman RN, MBA
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  7. Elliott S. Fisher MD, MPH
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Additional information

Drs. Woloshin and Schwartz are supported by a Veterans Affairs Fellowship in Ambulatory Care.

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Woloshin, S., Schwartz, L.M., Tosteson, A.N.A. et al. Perceived adequacy of tangible social support and health outcomes in patients with coronary artery disease. J GEN INTERN MED 12, 613–618 (1997). https://doi.org/10.1046/j.1525-1497.1997.07121.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.1997.07121.x

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