Longitudinal Psychosocial and Sleep Assessments for Long-Term Cardiovascular Risk Stratification after First...

Area of Science:

• Cardiology
• Clinical Epidemiology
• Health Outcomes Research

Background:

• The risk of myocardial infarction (MI) extends beyond the acute phase.
• In-hospital risk scores like the Global Registry of Acute Coronary Events (GRACE) may not fully capture long-term patient vulnerability.
• Predicting long-term major adverse cardiovascular events (MACE) requires refined prognostic tools.

Purpose of the Study:

• To evaluate if longitudinal clinical and patient-reported measures improve MACE prediction in first MI patients.
• To assess the incremental prognostic value of follow-up data beyond established risk scores.
• To identify simple, accessible measures for enhanced long-term cardiovascular risk stratification.

Main Methods:

• Prospective cohort study of 319 first MI patients in rural South India.
• MACE defined as cardiovascular death, non-fatal MI, stroke, heart failure hospitalization, or urgent revascularization.
• Longitudinal data collection included clinical, biochemical, psychosocial (PHQ-9, GAD-7), and sleep variables at 1, 6, and 12 months post-MI.
• Cox models incorporated GRACE score and follow-up variables; performance assessed using C-index and AUC.

Main Results:

• Over 5.8 years median follow-up, 29.5% of patients experienced MACE.
• The baseline model showed modest improvement over GRACE alone (C-index 0.622 vs. 0.556).
• The extended model with follow-up data demonstrated higher discrimination (optimism-corrected C-index 0.660).
• Follow-up sleep quality, psychosocial symptoms, glycemic control, and global longitudinal strain contributed to prediction.

Conclusions:

• Longitudinal follow-up measures offer modest incremental prognostic information for MACE beyond the GRACE score.
• These findings are exploratory and necessitate external validation for clinical application.
• Simple, patient-centered data collected post-MI can enhance long-term risk assessment.