1. Vital exhaustion predicts the progression of myocardial infarction-
a 2-year follow-up study
Beatrix Rafael1,2,3, Attila Simon4 , Peter Kovacs 5, Piroska Balog6
(1) University of Szeged, Institute of Psychology, (2) Special Hospital of Chest Illnesses, Deszk, (3) University of Szeged, Medical Rehabilitation and Physical Medicne
Department (4) State Hospital for Cardiology, Balatonfüred, (5) University of Szeged, Faculty of Economics and Business Administration, (6) Semmelweis University,
Institute of Behavioral Sciences, Budapest
BACKGROUND: It is known that cardiovascular disease, especially myocardial infarction (MI), is the leading cause of death both among men and women all over the world. There is growing evidence that besides important behavioural and somatic factors, psychological factors influence the development and prognosis of MI. Some researchers suggest that mortality and other long-term consequences of MI might be predicted by psychological conditions during the hospitalization.
PURPOSE:.Our aims were to determine the impact of psychological factors and somatic factors on the occurrence of new cardiac events and mortality after two years following MI. We examined patients with MI who were admitted to phase II residential cardiac rehabilitation programme.
METHODS: In patients (N=142, 99 men, mean age: 56) the level of depression (Shortened Beck Depression Inventory), anxiety (Spielberger Trate Anxiety Inventory), vital exhaustion (Shortened Maastricht Vital Exhaustion Questionnaire) and sleep disturbances (Athens Insomnia Scale) were assessed during the hospitalization after MI. Metabolic Equivalents (METs), and diabetes were retrieved from medical records. The main outcomes were: hospitalization because of cardiac event and all-cause mortality during 2 years.
RESULTS
During a two-year follow-up 19 patients died (14 because of cardiovascular causes) and 30 patients had (once or twice) new cardiac events.
Cox proportional hazard model showed that from the psychological and somatic factors only vital exhaustion and Metabolic Equivalents were predictive of mortality and the occurrence of new cardiac event adjustment for demographic factors (sex, age, marital status).
Table 1. Cox propotional hazard model: the prediction of psychological and somatic factors on progression of the disease
Fig.1. Kaplan-Meier analysis with baseline vital exhaustion
At baseline HR CI p
Vital exhaustion (high)
2,76
1,49-4,93
0,001
METs
0,72
0,60-0,86
0,033
Sex (woman)
0,242
Age
0,956
Marital status (alone)
0,103
Education (degree)
0,584
Diabetes (yes)
0,660
Currently smoking (yes)
0,081
Physical inactivity (yes)
0,438
Anxiety (high)
0,140
Depression (high)
0,121
Sleep disturbances (yes)
0,351
Baseline months months months montths
CONCLUSION
Psychological factors particularly vital exhaustion, play an important part in determining disease outcomes in patients with myocardial infarction. High level of vital exhaustion and low level of exercise capacity (METs) at baseline predicted progression of myocardial infarction (relapses/mortality) during the two-year follow-up. Therefore, it is essential to evaluate the mental and physical status of patients admitted to cardiac rehabilitation and initiate adequate therapy.
REFERENCES
CONTACTS
Nichols M, Townsend N, Scarborough P, Rayner M (2014) Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J, 35:
Everson-Rose SA, Lewis TT (2005) Psychosocial factors and cardiovascular diseases. Ann Rev Pub Health, 26:
My Declaration of interest: I have nothing to declare.