Feelings of being disabled as a risk factor for mortality up to 8 years after acute myocardial infarction.
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.
van der Vlugt
Maureen J
MJ
Thoraxcentre, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
van Domburg
Ron T
RT
Pedersen
Susanne S
SS
Veerhoek
Rinus J
RJ
Leenders
Ineke M
IM
Pop
George A M
GA
ter Keurs
Daan
D
Deckers
Jaap W
JW
Simoons
Maarten L
ML
Erdman
Ruud A M
RA
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