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High Self-Reported Levels of Pain 1 Year After a Myocardial Infarction Are Related to Long-Term All-Cause Mortality:
Linda Vixner1, Kristina Hambraeus2,3, Björn Äng1,2,4,5
1School of Health and Welfare Dalarna University Falun Sweden.
Insights
Pain one year after myocardial infarction (MI) significantly increases mortality risk. Moderate and extreme pain are linked to higher death rates, highlighting the need for pain management in post-MI patient care.
Area of Science:
- Cardiology
- Clinical Medicine
- Epidemiology
Background:
- Cardiovascular diseases, including myocardial infarction (MI), are associated with increased mortality risk.
- The long-term impact of post-MI pain on mortality has not been extensively studied.
- Investigating pain severity one year after MI is crucial for understanding long-term prognosis.
Purpose of the Study:
- To assess the association between pain severity one year post-MI and all-cause mortality.
- To determine if pain is a significant predictor of mortality in patients with a history of MI.
- To compare the predictive value of pain on mortality with other known risk factors like smoking.
Main Methods:
- Utilized data from 18,376 patients under 75 years old with a registered MI event (2004-2013) from the SWEDEHEART register.
- Assessed self-reported pain levels using the EuroQol-5 dimension instrument one year after hospital discharge.
- Employed Cox proportional hazard regression to analyze all-cause mortality data up to 8.5 years post-MI.
Main Results:
- Moderate pain (38.2%) and extreme pain (4.5%) were reported by a significant proportion of patients.
- Adjusted hazard ratios for all-cause mortality were 1.35 for moderate pain and 2.06 for extreme pain.
- Pain severity one year post-MI was identified as a stronger mortality predictor than smoking.
Conclusions:
- Pain is highly prevalent one year after myocardial infarction.
- Experienced pain one year post-MI is a significant predictor of all-cause mortality.
- Clinicians should integrate pain assessment into prognosis and treatment decisions for post-MI patients.
Abstract:
Background Pain increases the risk for cardiovascular diseases, including myocardial infarction (MI). However, the impact of pain on mortality after MI has not yet been investigated in large studies with long-term follow-up periods. Thus, we aimed to examine various levels of pain severity 1 year after an MI as a potential risk for all-cause mortality. Methods and Results We collected data from 18 376 patients, aged <75 years, who had a registered MI event during the period from 2004 to 2013 and with measurements of potential cardiovascular risk indicators at hospital discharge from the Swedish quality register SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies). Self-reported levels of experienced pain according to EuroQol-5 dimension instrument were recorded in secondary prevention clinics 1 year after hospital discharge. We collected all-cause mortality data up to 8.5 years (median, 3.4 years) after the 1-year visit. The Cox proportional hazard regression was used to estimate hazard ratio (HR) and 95% CI. Moderate pain and extreme pain were reported by 38.2% and 4.5%, respectively, of included patients. There were 1067 deaths. Adjusted HR was 1.35 (95% CI, 1.18-1.55) and 2.06 (95% CI, 1.63-2.60) for moderate and extreme pain, respectively. Pain was a stronger mortality predictor than smoking. Conclusions Pain 1 year after MI is highly prevalent, and its effect on mortality 1 year after MI was found to be more pronounced than smoking. Clinicians managing patients after MI should recognize the need to consider experienced pain when making prognosis or treatment decisions.
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Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...