Longitudinal study of patients after myocardial infarction: Sense of coherence, quality of life, and symptoms

Published:September 16, 2008DOI:


      Myocardial infarction has pronounced effects on an individual that demand changes in lifestyle. Health is influenced by whether the individual experiences the world as comprehensible, meaningful, and manageable, that is, has a sense of coherence (SOC). High SOC scores indicate that the individual probably manages the situation by understanding the context and connections: action and effect.


      The study objective was to identify the SOC, assess the quality of life (Short Form-12 Health Survey Questionnaire), assess the symptoms using the Seattle Angina Questionnaire, and create health curves from a baseline for patients with a first myocardial infarction.


      A longitudinal and predictive study of 100 participants in the heart care unit of a county hospital in southern Sweden was performed.


      Women score lower on SOC than men. Persons with high SOC scores have fewer angina attacks, are more physically active, drink more alcohol, are more satisfied with their treatments, and have better disease perception.


      By following SOC scores, a trend emerges that suggests it may be a useful tool for identifying those who will need extra support.
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        • World Health Organization
        WHO Cardiovascular disease.
        (Accessed October 5, 2007)
        • World Health Organization
        WHO's mortality database.
        (Accessed February 21, 2007)
        • Socialstyrelsen
        The Swedish National Board of Health and Welfare's Guidelines for Cardiac Care 2004.
        (Accessed October 5, 2007)
        • Yusuf S.
        • Hawken S.
        • Ounpuu S.
        • Dans T.
        • Avezum A.
        • Lanas F.
        • et al.
        Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (The INTERHEART Study): case-control study.
        Lancet. 2004; 364: 937-952
        • Bergman E.
        • Berterö C.
        “Grasp life again.” A qualitative study of the motive power in myocardial infarction patients.
        Eur J Cardiovasc Nurs. 2003; 2: 303-310
        • Bergman E.
        • Berterö C.
        You can do it if you set your mind to it: a qualitative study of patients with coronary artery disease.
        J Adv Nurs. 2001; 36: 733-741
        • Antonovsky A.
        Unraveling the mystery of health.
        Jossey-Bass Publishers, London1987
        • Antonovsky A.
        The structure and properties of the sense of coherence scale.
        Soc Sci Med. 1993; 36: 725-733
        • Ware J.E.
        • Kosinski M.
        • Keller S.
        A 12-item short-form health survey construction of Scales and preliminary tests of reliability and validity.
        Med Care. 1996; 34: 220-233
        • Sullivan M.
        • Karlsson J.
        • Taft C.
        Swedish manual and interpretation guide.
        2nd edition. Sahlgrenska University Hospital, Gothenburg2002
        • Kosinski M.
        Scoring the SF-12 Physical and Mental Health Summary Measures.
        Trust Bulletin. 1997; 5: 3-4
        • Lim L.L.
        • Fisher J.D.
        Use of the 12-item short-form (SF-12) health survey in an Australian heart and stroke population.
        Qual Life Res. 1999; 8: 1-8
        • Pickard A.S.
        • Johnson J.A.
        • Penn A.
        • Lau F.
        • Noseworthy T.
        Replicability of SF-36 summary scores by the SF-12 in stroke patients.
        Stroke. 1999; 30: 1213-1217
        • Brady S.
        • Thomas S.
        • Nolan R.
        • Brooks D.
        Pre-coronary artery bypass graft measures and enrollment in cardiac rehabilitation.
        J Cardiopulm Rehabil. 2005; 25: 343-349
        • Spertus J.A.
        • Winder J.A.
        • Dewhurst T.A.
        • Deyo R.A.
        • Proinzski J.
        • McDonell
        • Fihn S.
        Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease.
        J Am Coll Cardiol. 1995; 25: 333-341
        • Spertus J.A.
        • McDonell M.
        • Woodman C.
        • Fihn S.
        Association between depression and worse disease-specific functional status in outpatients' coronary artery disease.
        Am Heart J. 2002; 140: 105-110
        • Persson L.G.
        • Lindstrom K.
        • Lingfors H.
        • Bengtsson C.
        • Lissner L.
        Cardiovascular risk during early adult life.
        J Epidemiol Community Health. 1998; 52: 425-432
      1. Statistical Package for the Social Sciences. Version 15.0.
        SPSS, Chicago, IL2007
        • Hosmer D.
        • Lemeshow S.
        Applied logistic regression.
        Wiley, New York1989
        • Altman D.G.
        Practical statistics for medical research.
        Chapman & Hall/CRC, London1991
      2. Nilsson KW, Leppert J, Simonsson B, Starrin B. Sense of coherence (SOC) and psychological well-being (GHQ): its gets better as the years pass by. 2008 (in press).

        • Sullivan M.
        • Karlsson J.
        • Taft C.
        SF12 Hälsoenkät Svensk manual (SF-12 Health Survey, Swedish manual).
        Health Care Research Unit, Medical Faculty, Gothenburgh University, Göteborg, Sweden1997
        • Crilley J.G.
        • Farrer M.
        Impact of first myocardial infarction on self-perceived health status.
        Q J Med. 2001; 94: 13-18
        • Nilsson B.
        • Holmgren L.
        • Westman G.
        Sense of coherence in different stages of health and disease in northern Sweden—gender and psychosocial differences.
        Scand J Prim Health Care. 2000; 18: 14-20
        • Nilsson B.
        • Holmgren L.
        • Stegmayr B.
        • Westman G.
        Sense of coherence—stability over time and relation to health, disease, and psychosocial changes in a general population: a longitudinal study.
        Scand J Public Health. 2003; 31: 297-304
        • Eriksson M.
        • Lindstrom B.
        Antonovsky's sense of coherence scale and the relation with health: a systematic review.
        J Epidemiol Community Health. 2006; 60: 376-381
        • Kattainen E.
        • Merilainen P.
        • Sintonen H.
        Sense of coherence and health-related quality of life among patients undergoing coronary artery bypass grafting or angioplasty.
        Eur J Cardiovasc Nurs. 2006; 5: 21-30
        • Ekman I.
        • Fagerberg B.
        • Lundman B.
        Health-related quality of life and sense of coherence among elderly patients with severe chronic heart failure in comparison with healthy controls.
        Heart Lung. 2002; 31: 94-101
        • Poppius E.
        • Tenkanen L.
        • Kalimo R.
        • Heinsalmi P.
        The sense of coherence, occupation and the risk of coronary heart disease in the Helsinki Heart Study.
        Soc Sci Med. 1999; 49: 109-120
        • Mittag O.
        Findings on gender differences in the quality of care in cardiac rehabilitation: are women discriminated against?.
        Rehabilitation (Stuttg). 2003; 42: 204-210
        • Yohannes A.M.
        • Yalfani A.
        • Doherty P.
        • Bundy C.
        Predictors of drop-out from an outpatient cardiac rehabilitation programme.
        Clin Rehabil. 2007; 21: 222-229
        • Ware J.
        • Kosinski M.
        • Turner-Bowker D.
        How to score version 2 of the Health Survey.
        QualityMetric, Lincoln, RI2002
        • Antonovsky A.
        The salutogenic model as a theory to guide health promotion.
        Health Promot Int. 1996; 11: 11-18
        • Eriksson M.
        Unraveling the mystery of salutogenesis: the evidence base of the salutogenic research as measured by Antonovsky's Sense of Coherence Scale. Dissertation.
        Public Health Research Centre, Åbo2007
        • Wainwright N.W.
        • Surtees P.G.
        • Welch A.A.
        • Luben R.N.
        • Khaw K.T.
        • Bingham S.A.
        Healthy lifestyle choices: could sense of coherence aid health promotion?.
        J Epidemiol Community Health. 2007; 61: 871-876
        • Feldt E.
        • Leskinen E.
        • Kinnunen U.
        Structural invariance and stability of sense of coherence: a longitudinal analysis of two groups with different employment experiences.
        Work Stress. 2005; 19: 68-83
        • Fok S.K.
        • Chair S.Y.
        • Lopez V.
        Sense of coherence, coping and quality of life following a critical illness.
        J Adv Nurs. 2005; 49: 173-181
        • Kivimäki M.
        • Feldt T.
        • Vahtera J.
        • Nurmi J.E.
        Sense of coherence and health: evidence from two cross-lagged longitudinal samples.
        Soc Sci Med. 2000; 50: 583-597
        • Karlsson I.
        • Rasmussen C.
        • Ravn J.
        Chest pain after coronary artery bypass: relation to coping capacity and quality of life.
        Scand Cardiovasc J. 2002; 36: 41-47
        • Lingfors H.
        • Lindstrom K.
        • Persson L.G.
        • Bengtsson C.
        • Lissner L.
        Lifestyle changes after a health dialogue.
        Scand J Prim Health Care. 2003; 21: 248-252
        • Bergh H.
        • Baigi A.
        • Fridlund B.
        • Marklund B.
        Life events, social support and sense of coherence among frequent attenders in primary health care.
        Public Health. 2006; 120: 229-236
        • Philips B.
        • de Lemos J.A.
        • Patel M.J.
        • McGuire D.K.
        • Khera A.
        Relation of family history of myocardial infarction and the presence of coronary arterial calcium in various age and risk factor groups.
        Am J Cardiol. 2007; 99: 825-829
        • Lindstrom B.
        • Eriksson M.
        J Epidemiol Community Health. 2005; 59: 440-442
        • Eriksson M.
        • Lindstrom B.
        Validity of Antonovsky's sense of coherence scale: a systematic review.
        J Epidemiol Community Health. 2005; 59: 460-466
        • Karlsson I.
        • Berglin E.
        • Larsson P.
        Sense of coherence: quality of life before and after coronary artery bypass surgery—a longitudinal study.
        J Adv Nurs. 2000; 31: 1383-1392