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Self-reported pain is associated with a poorer long-term prognosis in patients with myocardial infarction: A
Lars Berglund1,2,3, Ann-Sofie Rönnegård1,4, Bertil Lindahl5
1School of Health and Welfare, Dalarna University, Falun, Sweden.
Insights
Pain after myocardial infarction (MI) is common and increases cardiovascular risk. This risk is comparable to smoking, diabetes, and hypertension, impacting prognosis and treatment decisions.
Area of Science:
- Cardiology
- Public Health
- Pain Medicine
Background:
- Cardiovascular risk is linked to pain, but post-myocardial infarction (MI) pain prognosis is understudied.
- General pain following MI may serve as a prognostic marker for major adverse cardiovascular events (MACE) and mortality.
Purpose of the Study:
- To evaluate the association between general pain reported one-year post-MI and subsequent MACE and all-cause mortality.
- To determine the prognostic significance of moderate and extreme pain in men and women after MI.
Main Methods:
- Analysis of data from 98,441 MI patients (aged 22-79) from the Swedish quality register SWEDEHEART.
- Pain severity (EuroQol-5) recorded one-year post-MI; follow-up up to 16 years for MACE and mortality.
- Adjusted Cox regression models used to assess associations, calculating hazard ratios (HR) and population attributable fractions (PAF).
Main Results:
- Moderate pain (38.0%) and extreme pain (5.0%) were significantly associated with increased all-cause mortality in both men and women.
- Population attributable fractions for pain were comparable to those for smoking, diabetes, and hypertension.
- Associations with MACE were similar to all-cause mortality, particularly in women.
Conclusions:
- Self-reported pain post-MI is prevalent and indicates elevated cardiovascular risk.
- General pain prognosis post-MI is significant and comparable to established risk factors like smoking and hypertension.
- Clinicians should consider general pain in risk assessment and treatment strategies for MI patients, including those without chest pain.
Background:
Pain is associated with cardiovascular risk, but its prognosis after myocardial infarction (MI) is less studied. We evaluated general pain post-MI as a marker for MACE (all-cause mortality, recurrent MI, or stroke) and all-cause mortality.
Methods And Results:
We collected data from 98,441 MI patients (22-79 years) from the Swedish quality register SWEDEHEART. Pain, measured by EuroQol-5, was recorded one-year post-MI. Moderate pain was reported by 38.0 % of the patients and extreme pain by 5.0 %. During follow-up (up to 16.0 years (median 5.5 years)) there were 14,944 deaths and 24,910 MACEs.In adjusted Cox regression models, moderate and extreme pain were associated with all-cause mortality in men (hazard ratio (HR) 1.24, 95 % confidence interval (CI) 1.19-1.29 and HR 1.70, 95 % CI 1.54-1.86, respectively,) and in women (HR 1.15, 95 % CI 1.08-1.23 and HR 1.31, 95 % CI 1.16-1.48, respectively,). The population attributable fraction (PAF) for moderate and extreme pain combined, with outcome all-cause mortality, was 8.3% for men and 6.3 % for women, similar to PAF for smoking, diabetes, and hypertension. Compared to all-cause mortality, HRs for MACE were somewhat lower in men and similar in women. For patients with lower cardiovascular risk defined, among other factors, by absence of chest pain, HRs were comparable to those in the main sample.
Conclusions:
Self-reported pain after MI was common and linked to increased cardiovascular risk, similar to that of smoking, diabetes, and hypertension. Clinicians may consider general pain in prognosis and treatment, even for patients without chest pain.
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