Distress related to myocardial infarction and cardiovascular outcome: a retrospective observational study

Abstract

BackgroundDuring acute coronary syndromes patients perceive intense distress. We hypothesized that retrospective ratings of patients' MI-related fear of dying, helplessness, or pain, all assessed within the first year post-MI, are associated with poor cardiovascular outcome.MethodsWe studied 304 patients (61 ± 11 years, 85% men) who after a median of 52 days (range 12-365 days) after index MI retrospectively rated the level of distress in the form of fear of dying, helplessness, or pain they had perceived at the time of MI on a numeric scale ranging from 0 ("no distress") to 10 ("extreme distress"). Non-fatal hospital readmissions due to cardiovascular disease (CVD) related events (i.e., recurrent MI, elective and non-elective stent implantation, bypass surgery, pacemaker implantation, cerebrovascular incidents) were assessed at follow-up. The relative CVD event risk was computed for a (clinically meaningful) 2-point increase of distress using Cox proportional hazard models.ResultsDuring a median follow-up of 32 months (range 16-45), 45 patients (14.8%) experienced a CVD-related event requiring hospital readmission. Greater fear of dying (HR 1.21, 95% CI 1.03-1.43), helplessness (HR 1.22, 95% CI 1.04-1.44), or pain (HR 1.27, 95% CI 1.02-1.58) were significantly associated with an increased CVD risk without adjustment for covariates. A similarly increased relative risk emerged in patients with an unscheduled CVD-related hospital readmission, i.e., when excluding patients with elective stenting (fear of dying: HR 1.26, 95% CI 1.05-1.51; helplessness: 1.26, 95% CI 1.05-1.52; pain: HR 1.30, 95% CI 1.01-1.66). In the fully-adjusted models controlling for age, the number of diseased coronary vessels, hypertension, and smoking, HRs were 1.24 (95% CI 1.04-1.46) for fear of dying, 1.26 (95% CI 1.06-1.50) for helplessness, and 1.26 (95% CI 1.01-1.57) for pain.ConclusionsRetrospectively perceived MI-related distress in the form of fear of dying, helplessness, or pain was associated with non-fatal cardiovascular outcome independent of other important prognostic factors.

Association of Trait Resilience With Peritraumatic and Posttraumatic Stress in Patients With Myocardial Infarction

“…Among the trauma-specific variables, troponin T peak level was not significantly associated with peritraumatic distress, which is in agreement with previous studies (2). In contrast, the direct association between peak troponin T level and the PDS score was an unexpected finding.…”

“…Approximately 70% of patients perceive peritraumatic distress during MI in the form, for instance, of intense fear (of dying) and stressful feelings (1,2). There are numerous predictors for increased peritraumatic distress, including female sex, lower education, emotional upset before MI, and pain intensity during MI (1).…”

Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology

“…66 Some patients may be anxious about their prognosis, and about possible physical, sexual, social and occupational incapacity. Some may avoid any physical activity, emotional exertion, sex and other activities, fearing that these may be harmful to their health.…”

“…3,4,38 It is important to recognise the existence, interaction and relevance of these mechanisms (Table 2) 10, and of common genetic variants such as the serotonin transporter polymorphism or polymorphisms of inflammatory biomarkers which are linked to depression and CHD. 64 Whilst PSRFs such as anxiety and depression may affect the cardiovascular system through biological and behavioral pathways, it must also be emphasized that CHD and its treatments may, in turn, evoke stress 65,66 and bring forth PSRFs like depression and posttraumatic stress disorder (PTSD). 67,68 The impact of CHD on partners is important, as partners have the potential to affect patients' responses to their diagnosis and management.…”

What to do after cardiac rehabilitation programs: the role of the general practitioner in cardiovascular prevention

“…The diagnosis of coronary heart disease and, in turn, its treatments may evoke stress [41] and lead to depression and the development of posttraumatic stress disorder. The impact of these conditions on patients' partners is important, as partners have the potential to affect patients' responses to their diagnosis and management [42].…”