title: Feelings of being disabled as a risk factor for mortality up to 8 years after acute myocardial infarction.
abstract: OBJECTIVE
  We examined the independent prognostic value of the four subscales of the Heart Patients Psychological Questionnaire (HPPQ) on mortality in acute myocardial infarction (AMI) survivors up to 8 years after the event.
  
  
  METHODS
  The HPPQ, which measures well-being, feelings of being disabled, despondency and social inhibition, was administered to 567 AMI patients during hospitalisation and at 3 months follow-up. The patients were followed for 8 years.
  
  
  RESULTS
  During follow-up, 157 patients (28%) died. Forty-one percent of the patients had a score indicating at least mild to moderate feelings of being disabled. Patients with feelings of being disabled were at increased risk of mortality compared with those having a low score, adjusted for other cardiac risk factors [hazard ratio (HR)=1.8, 95% confidence interval (CI)=1.3-2.5]. There was no interaction between feelings of being disabled and gender. None of the other HPPQ subscales were related to mortality or recurrent myocardial infarction (MI). When the study population was stratified by low and high clinical risk (43% vs. 57%, respectively), feelings of being disabled was the most prominent predictor of mortality in the low-risk group (HR=3.5, 95% CI=1.4-8.8).
  
  
  CONCLUSIONS
  Feelings of being disabled measured at baseline and at 3 months was the most prominent predictor of mortality in low-risk patients 8 years post-MI. This finding adds to the existing knowledge that psychosocial variables influence morbidity and mortality in cardiac patients.
authors.affiliation: Thoraxcentre, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Maureen J
authors.initials: MJ
authors.lastname: van der Vlugt
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
authors.forename: Rinus J
authors.initials: RJ
authors.lastname: Veerhoek
authors.forename: Ineke M
authors.initials: IM
authors.lastname: Leenders
authors.forename: George A M
authors.initials: GA
authors.lastname: Pop
authors.forename: Daan
authors.initials: D
authors.lastname: ter Keurs
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Deckers
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
authors.forename: Ruud A M
authors.initials: RA
authors.lastname: Erdman
mesh_terms: D001293:Attitude to Death; D001294:Attitude to Health; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology*; D011584:Psychology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors