title: Vital exhaustion and cardiovascular prognosis in myocardial infarction and heart failure: predictive power of different trajectories.
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.
  
  
  METHODS
  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.
authors.affiliation: CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.
authors.forename: O R F
authors.initials: OR
authors.lastname: Smith
authors.forename: N
authors.initials: N
authors.lastname: Kupper
authors.forename: J
authors.initials: J
authors.lastname: Denollet
authors.forename: P
authors.initials: P
authors.lastname: de Jonge
mesh_terms: D000368:Aged; D057565:Apathy; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D005221:Fatigue / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D009426:Netherlands; D010359:Patient Readmission; D011379:Prognosis; D018570:Risk Assessment; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D016019:Survival Analysis