The Prognostic Effect of Physical Health Complaints With New Cardiac Events and Mortality in Patients With a Myocardial Infarction.

BACKGROUND

Self-rated general health has been associated with worse outcome after a myocardial infarction (MI). Previously, however, concurrent depression or anxiety was not taken into account.

OBJECTIVE

To evaluate the effect of physical health complaints post-MI on cardiac prognosis adjusting for cardiac disease severity, depression, and anxiety.

METHODS

The somatic subscale of the Health Complaints Scale was administered to 424 patients with MI at 3 and 12 months post-MI. Types and trajectories of health complaints were identified with latent transition analysis. The prognostic effect of Health Complaints Scale sum-score at 3 months, and of types and trajectories of health complaints on combined end points (new cardiac events and mortality) was evaluated with Cox regression. Adjustments were made for age, sex, education level, living alone, history of MI, left ventricular ejection fraction, depressive symptoms, and generalized anxiety disorder.

RESULTS

Overall, 189 (44.9%) patients with MI had a cardiac event or died during a mean follow-up of 5.7 (3.1) years. In the fully adjusted model, Health Complaints Scale sum-score predicted outcome (hazard ratio [HR] = 1.02 [95% CI: 1.00-1.05]). Latent transition analysis distinguished 5 groups at 3 and 12 months characterized by (1) no/minimal complaints, (2) cardiac complaints, (3) lack of energy, (4) sleep problems, and (5) mixed health complaints, resulting in 25 transition classes. Patients with cardiac and energy complaints at 3 months (HRcardiac = 1.55 [1.15-2.10] and HRenergy = 1.35[1.00-1.81]) and those with new or persistent cardiac, energy, and mixed complaints over time had a worse prognosis (HRcardiac = 1.55 [1.11-2.16], HRmixed = 1.71 [1.19-2.47], and HRenergy = 1.51 [1.09-2.08]).

CONCLUSIONS

Physical health complaints are predictors of cardiac outcome independent from cardiac disease, depression, and anxiety. Type and trajectories of health complaints may have additional prognostic significance.