A 2-point increase in retrospectively perceived MI-related fear of dying was associated with a 24% increased risk of non-fatal cardiovascular hospital readmission (HR 1.24).
Observational (n=304)
No
Is retrospectively perceived MI-related distress associated with an increased risk of non-fatal cardiovascular events in patients post-MI?
Retrospectively perceived distress during an MI, including fear of dying, helplessness, and pain, is independently associated with an increased risk of subsequent non-fatal cardiovascular events.
Effect estimate: HR 1.24 (95% CI 1.04-1.46)
p-value: p=0.015
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.
Känel et al. (Fri,) conducted a observational in Myocardial infarction (n=304). MI-related distress (fear of dying, helplessness, or pain) vs. Lower distress scores was evaluated on Non-fatal hospital readmissions due to cardiovascular disease-related events (HR 1.24, 95% CI 1.04-1.46, p=0.015). A 2-point increase in retrospectively perceived MI-related fear of dying was associated with a 24% increased risk of non-fatal cardiovascular hospital readmission (HR 1.24).