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Vital exhaustion and cardiovascular prognosis in myocardial infarction and heart failure: predictive power of different trajectories

Published online by Cambridge University Press:  16 June 2010

O. R. F. Smith ,
N. Kupper ,
J. Denollet  and
P. de Jonge
O. R. F. Smith
Affiliation:
CoRPS – Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
N. Kupper
Affiliation:
CoRPS – Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
J. Denollet
Affiliation:
CoRPS – Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
P. de Jonge*
Affiliation:
CoRPS – Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands Interdisciplinary Center of Psychiatric Epidemiology, Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
*
*Address for correspondence: Peter de Jonge, Ph.D., CoRPS – Center of Research on Psychology in Somatic Diseases, Tilburg University, Department of Medical Psychology, PO Box 90153, 5000 LE Tilburg, The Netherlands. (Email: [email protected])
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Abstract

Background

We examined the different trajectories of vital exhaustion (VE) over a 12-month period and their impact on prognosis in a sample of myocardial infarction (MI) and chronic heart failure (CHF) patients.

Method

Consecutive MI (n=407) and CHF patients (n=297) were assessed at baseline, and at 3- and 12-month follow-up for symptoms of VE. Latent growth mixture modelling was used to examine the course of VE over time. The combined clinical endpoint was defined as cardiac hospital readmission or death.

Results

Four distinct trajectories for VE were found: low VE, decreasing VE, increasing VE, and severe VE. Sex, marital status, left ventricular ejection fraction, psychotropic medication, sample group (CHF v. MI) and depressive symptoms were associated with VE, varying according to classes. The mean follow-up period was 25.3 months in which 34.7% of the patients experienced an event. Multivariate Cox regression showed that, compared with patients in the low VE class, patients in the increasing VE class [hazard ratio (HR)=1.16, 95% confidence interval (CI) 1.58–3.61, p=0.01], and the severe VE class (HR=1.69, 95% CI 1.31–2.64, p=0.02) had an increased risk for adverse cardiovascular events (i.e. cardiovascular hospital readmission or cardiovascular death). Decreasing VE was not related to adverse cardiovascular events (HR=0.97, 95% CI 0.66–1.69, p=0.81).

Conclusions

VE trajectories varied across cardiac patients, and had a differential effect on cardiovascular outcome. Increasing VE and severe VE classes were predictors of poor cardiovascular prognosis. These results suggest that identification of cardiac patients with an increased risk of adverse health outcomes should be based on multiple assessments of VE.

Keywords

Cardiovascular outcomedepressionheart diseasevital exhaustion
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 4 , April 2011 , pp. 731 - 738
Copyright
Copyright © Cambridge University Press 2010

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