Effects of treating exhaustion in angioplasty patients on new coronary events: results of the randomized Exhaustion Intervention Trial (EXIT).
BACKGROUND
Extreme fatigue is a common complaint in percutaneous coronary intervention (PCI) patients, and is associated with an increased risk for new cardiac events. The objective of the Exhaustion Intervention Trial (EXIT) was to determine whether a behavioral intervention on exhaustion reduces the risk of a new coronary event after PCI.


RESULTS
Seven hundred ten consecutive patients, ages 35 to 68 years, who felt exhausted after PCI were randomized into an intervention group and a usual-care group. The intervention was based on group therapy focusing on stressors leading to exhaustion, and on support for recovery by promoting rest and making rest more efficient. One month after PCI, 50% of the patients felt exhausted. The intervention reduced the odds of remaining exhausted at 18 months by 56% in those without a previous history of coronary artery disease (CAD) (OR = 0.44; 95% CI 0.29-0.66), but had no effect on exhaustion in those with a history of CAD (OR = 0.93; 95% CI 0.56-1.55; p = .78). The intervention did not reduce the risk of a new coronary event within 2 years (RR = 1.14; 95%CI 0.82-1.57). Post-hoc analyses suggest that the effect of the intervention was limited by a positive history of CAD, the presence of a chronic, painful condition (especially rheumatism), and by opposite effects on early and late cardiac events.


CONCLUSIONS
A behavioral intervention in PCI patients has a beneficial effect on feelings of exhaustion. It could not be demonstrated that the intervention reduces the risk of a new coronary event within 2 years.
Appels
Ad
A
Department of Medical Psychology, Maastricht University, Maastricht, The Netherlands. Ad.Appels@MP.unimaas.nl
Bär
Frits
F
van der Pol
Gerda
G
Erdman
Ruud
R
Assman
Maarten
M
Trijsburg
Wim
W
van Diest
Rob
R
van Dixhoorn
Jan
J
Mendes de Leon
Carlos
C
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001521:Behavior Therapy / Q000379:methods*; D003324:Coronary Artery Disease / Q000517:prevention & control / Q000628:therapy*; D005221:Fatigue / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011615:Psychotherapy, Group / Q000379:methods; D012146:Rest; D018570:Risk Assessment / Q000706:statistics & numerical data; D055502:Secondary Prevention; D013315:Stress, Psychological / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome