Self-reported pain after MI associated with long-term all-cause mortality
Researchers in Sweden found that patients who had had a myocardial infarction (MI) and reported moderate or severe musculoskeletal pain one year after hospital discharge were at higher risk for death than those without pain.
Patients who have had a myocardial infarction (MI) and report pain one year later may be at higher risk for death, a recent study found.
Researchers used a Swedish quality database to evaluate pain severity in patients younger than age 75 years who had had an MI from 2004 to 2013. The EuroQol-5 instrument was used to record self-reported pain levels during visits to secondary prevention clinics one year after hospital discharge, and all-cause mortality was collected for an additional 8.5 years (median, 3.4 years). All-cause mortality as determined from the Swedish National Population Registry was the study's primary outcome, and both pain and smoking 12 months after hospitalization were evaluated as predictors of mortality. The results were published Aug. 16 by the Journal of the American Heart Association.
Overall, 18,376 patients were included in the study (mean age, 62.0 years; 75% men). Of these, 57.2% reported no pain at one year, 38.2% reported moderate pain, and 4.5% reported extreme pain. A total of 1,067 patients died, 4.0% of those who reported no pain at one year, 7.7% of those who reported moderate pain, and 12.5% of those who reported extreme pain. The adjusted hazard ratios for death were 1.35 (95% CI, 1.18 to 1.55) in patients who reported moderate pain at one year and 2.06 (95% CI, 1.63 to 2.60) in those who reported extreme pain. C-statistics were 0.60 for pain and 0.55 for smoking (95% CI for the difference, 0.03 to 0.07).
The authors noted that they could not analyze cause-specific mortality or adjust for sociodemographic variables or use of pain medications, among other limitations. They concluded that pain is highly common one year after an MI and has a substantial connection to mortality, especially among those who report severe pain. “Clinicians managing patients after MI should recognize the need to consider experienced pain as a prognostic factor comparable to persistent smoking, and to address this when designing individually adjusted [cardiac rehabilitation] and secondary prevention treatments,” the authors wrote.