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BMC Psychiatry. 2011; 11: 98.
Published online Jun 10, 2011. doi:  10.1186/1471-244X-11-98
PMCID: PMC3126764
Distress related to myocardial infarction and cardiovascular outcome: a retrospective observational study
Roland von Känel,corresponding author1,2 Roman Hari,1 Jean-Paul Schmid,2 Hugo Saner,2 and Stefan Begré1
1Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, and University of Bern, Switzerland
2Swiss Cardiovascular Center, Cardiovascular Prevention and Rehabilitation, Inselspital, Bern University Hospital, and University of Bern, Switzerland
corresponding authorCorresponding author.
Roland von Känel: roland.vonkaenel/at/insel.ch; Roman Hari: rumen/at/sunrise.ch; Jean-Paul Schmid: jean-paul.schmid/at/insel.ch; Hugo Saner: hugo.saner/at/insel.ch; Stefan Begré: stefan.begre/at/insel.ch
Received October 12, 2010; Accepted June 10, 2011.
Abstract
Background
During 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.
Methods
We 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.
Results
During 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.
Conclusions
Retrospectively 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.
Keywords: Myocardial infarction, pain, retrospective study, psychological stress, risk factor
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