Temporal changes in myocardial infarction incidence rates are associated with periods of perceived psychosocial stress: A SWEDEHEART national registry study

Wallert, John; Held, Claes; Madison, Guy; Olsson, Erik

doi:10.1016/j.ahj.2017.05.015

Cited by 12 publications

(12 citation statements)

References 25 publications

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“…Contrary to our expectations no increased risk for MINOCA was detected during the Christmas days or during the two weeks including Christmas Eve, Christmas Day and New Year’s Eve. This finding differs with two recent studies on all Swedish MI patients demonstrating a significant increase of traditional MI-CAD during Christmas [6, 7] and New Year holidays [7]. No change in the incidence of MINOCA was nor noted during the Swedish Midsummer festivities, further indicating the difference between the pathophysiological mechanisms for MINOCA and MI, the latter having a strong association with the presence of sunlight [20, 24].…”

Section: Discussioncontrasting

confidence: 87%

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Circadian onset and prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA)

et al. 2019

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Background Many acute cardiovascular events such as myocardial infarction (MI) follow circadian rhythms. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a newly noticed entity with limited data on onset pattern and its impact on prognosis. Material and methods In this observational study of Swedish MINOCA patients registered in the SWEDEHEART registry between 2003–2013 and followed until December 2013 we identified 9,092 unique patients with MINOCA out of 199,163 MI admissions in total. Incidence rate ratios (IRR) were calculated for whole hours, parts of the day, weekdays, months, seasons and major holidays. Results The mean age was 65.5 years, 62.0% were women and 16.6% presented with STEMI. The risk for MINOCA proved to be most common in the morning (IRR = 1.70, 95% CI [1.63–1.84]) with a peak at 08.00 AM (IRR = 2.25, 95% CI [1.96–2.59]) and on Mondays (IRR = 1.28, 95% CI [1.18–1.38]). No altered risk was detected during the different seasons, the Christmas and New Year holidays or the Swedish Midsummer festivities. There was no association between time of onset of MINOCA and short- or long-term prognosis. Conclusion The onset of MINOCA shows a circadian and circaseptan variation with increased risk at early mornings and Mondays, similar to previous studies on all MI, suggesting stress related triggering. However, during holidays were traditional MI increase, we did not see any increase for MINOCA. No association was detected between time of onset and prognosis, indicating that the underlying pathological mechanisms of MINOCA and the quality of care are similar at different times of onset but triggering mechanism may be more active early mornings and Mondays.

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Section: Discussioncontrasting

confidence: 87%

“…In addition to a circadian rhythm, the onset of MI has a weekly rhythm [6–8] with higher rates on Mondays and a seasonal rhythm [7, 9] with higher rates of onset during winter. Increased rates of MI have also been noted during Christmas and New Year holidays [6, 7].…”

Section: Introductionmentioning

confidence: 99%

Circadian onset and prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA)

et al. 2019

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“…Finally, decreased physical activity and professional stress subsequent to the lockdown might also have contributed to a genuine decrease in the number of acute myocardial infarctions. 16 The fact that we observed no catch-up phenomenon during the first 4 weeks after the lockdown might also suggest a true decrease in the occurrence of acute myocardial infarction.…”

Section: Discussionmentioning

confidence: 64%

Hospital admissions for acute myocardial infarction before and after lockdown according to regional prevalence of COVID-19 and patient profile in France: a registry study

Mesnier

Cottin

Coste

et al. 2020

The Lancet Public Health

187

192

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Background The COVID-19 pandemic has had a profound effect on general health care. We aimed to evaluate the effect of a nationwide lockdown in France on admissions to hospital for acute myocardial infarction, by patient characteristics and regional prevalence of the pandemic. Methods In this registry study, we collected data from 21 centres participating in the ongoing French Cohort of Myocardial Infarction Evaluation (FRENCHIE) registry, which collects data from all patients admitted for ST segment elevation myocardial infarction (STEMI) or non-ST segment elevation myocardial infarction (NSTEMI) within 48 h of symptom onset. We analysed weekly hospital admissions over 8 weeks: the 4 weeks preceding the institution of the lockdown and the 4 weeks following lockdown. The primary outcome was the change in the number of hospital admissions for all types of acute myocardial infarction, NSTEMI, and STEMI between the 4 weeks before lockdown and the 4 weeks after lockdown. Comparisons between categorical variables were made using χ² tests or Fisher's exact tests. Comparisons of continuous variables were made using Student's t tests or Mann-Whitney tests. Poisson regression was used to determine the significance of change in hospital admissions over the two periods, after verifying the absence of overdispersion. Age category, region, and type of acute myocardial infarction (STEMI or NSTEMI) were used as covariables. The FRENCHIE cohort is registered with ClinicalTrials.gov, NCT04050956. Findings Between Feb 17 and April 12, 2020, 1167 patients were consecutively admitted within 48 h of acute myocardial infarction (583 with STEMI, 584 with NSTEMI) and were included in the study. Admissions for acute myocardial infarction decreased between the periods before and after lockdown was instituted, from 686 before to 481 after lockdown (30% decrease; incidence rate ratio 0⋅69 [95% CI 0⋅51-0⋅70]). Admissions for STEMI decreased from 331 to 252 (24%; 0⋅72 [0⋅62-0⋅85]), and admissions for NSTEMI decreased from 355 to 229 (35%; 0⋅64 [0⋅55-0⋅76]) following institution of the lockdown, with similar trends according to sex, risk factors, and regional prevalence of hospital admissions for COVID-19. Interpretation A marked decrease in hospital admissions was observed following the lockdown, irrespective of patient characteristics and regional prevalence of COVID-19. Health authorities should be aware of these findings, in order to adapt their message if the COVID-19 pandemic persists or recurs, or in case of future major epidemics. Funding Recherche Hospitalo-Universitaire en Santé iVasc.

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“…The critical relationship between life stress and the heart is perhaps most effectively illustrated by Takotsubo syndrome, which is classically triggered by acute emotional stressors, such as the loss of a loved one 17 . A significant increase in myocardial infarction incidence is established around potentially stressful times of the year, especially Mondays, Christmas and New Year's, and spring daylight savings [18][19][20][21] . Temporal relationships between SCD and acutely stressful events, J o u r n a l P r e -p r o o f such as extreme threats to personal safety or hearing of a loved one's death, have also been reported 22 .…”

Section: Discussionmentioning

confidence: 99%

Potential Role of Life Stress in Unexplained Sudden Cardiac Arrest

et al. 2021

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Background The etiology of sudden cardiac arrest (SCA) in individuals without known cardiovascular heart disease remains elusive in nearly half of all patients after systematic testing. We investigated the relationship between stressful life events and SCA risk in cases of explained and unexplained SCA (USCA) events. Methods Individuals who previously experienced SCA were enrolled prospectively and divided into a USCA or explained SCA (ESCA) subgroup dependent on whether a diagnosis was ascribed after SCA. Participants completed either the 1997 Recent Life Changes Questionnaire, Student Stress Scale, or Social Re-adjustment Rating Scale for Non-Adults recalling events during the year preceding their SCA, depending on age at SCA presentation; all measure stress in life change units (LCUs). SCA group scores were compared with an age- and sex-matched control group. Results We compared 36 SCA group participants (22 USCA, 14 ESCA, age 47 ± 15 years, age at SCA 40 ± 14 years, 50% male) with 36 control participants (age 47 ± 15 years, 50% male). There was no significant difference in LCU score between the control group and the SCA group (248 ± 181 LCU vs 252 ± 227 LCU; P > .05). The ESCA subgroup had significantly lower mean LCU scores than the USCA subgroup (163 ± 183 LCU vs 308 ± 237 LCU; P = .030). Conclusions Stressful life events, especially those producing chronic stress, might predispose otherwise healthy individuals to lethal arrhythmias. Further investigation into the role of stress in SCA precipitation is warranted.

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Temporal changes in myocardial infarction incidence rates are associated with periods of perceived psychosocial stress: A SWEDEHEART national registry study

Abstract: Fluctuations in daily MI incidence rates are systematically related to time periods of presumed psychosocial stress. Further research might clarify mechanisms that are amenable to clinical alteration.

Cited by 12 publications

References 25 publications

Circadian onset and prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA)

Circadian onset and prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA)

Hospital admissions for acute myocardial infarction before and after lockdown according to regional prevalence of COVID-19 and patient profile in France: a registry study

Potential Role of Life Stress in Unexplained Sudden Cardiac Arrest

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