Ninety-eight men aged <60 years with a first myocardial infarction were followed for 6 months. The aim was to characterize patients who succeeded in changing their lifestyles by modifying risk factors and to correlate them to subjective and objective outcome. We focused on the interplay between the patient's causal attribution of the infarction and compared this with the influence of background factors. The patient attribution most often predicted positive objective outcome and subjective functioning. This study shows that background factors are of prognostic value, but the patient's attribution and his own ideas about coping add information on the outcome of the rehabilitation as evaluated by more specific outcome measures.