Abstract 10784: Major Life Events Prior to Hospitalization for Acute Myocardial Infarction are Associated with Worse Outcomes at 1 Year
Background: Major adverse life events are associated with increased risk of acute myocardial infarction (AMI), but little is known about whether these life events influence post-AMI outcomes during the first year of recovery.
Methods: In the 24-site prospective TRIUMPH study, patients were asked if they experienced 9 specified major adverse life events in the year prior to hospitalization for AMI. Cox proportional hazards, logistic, and linear regression examined whether the cumulative number of life events (0, 1, or ≥2) was associated with 1-year outcomes, including all-cause rehospitalization, cardiac-related health status (Seattle Angina Questionnaire angina and quality of life scales), general physical and mental functioning (Short Form-12), and depressive symptoms (Patient Health Questionnaire-8). Hierarchical models adjusted for clustering within sites and 21 sociodemographic and clinical factors.
Results: Of 1413 patients completing the life events questionnaire, 441 (31%) reported ≥2 events, 444 (31%) reported 1 event, and 528 (37%) reported no adverse events. The most commonly reported event was death or major illness of a close family member or friend (32% of cohort), followed by major personal injury or illness (22%), major intrafamily conflict (16%), loss of job or retirement (13%), violence (4%), marital separation or divorce (4%), crop loss or business failure (4%), and death of spouse (2%); 17% reported other major stressors. Patients with ≥2 events in the prior year had worse outcomes at 1 year post-AMI compared to those with no events, including greater risk of rehospitalization (hazard ratio 1.40; 95% confidence interval [CI] 1.04, 1.90), poorer cardiac-related quality of life (beta -3.91; 95% CI -7.27, -0.55), poorer general physical (beta -2.08; 95% CI -3.83, -0.34) and mental (beta -2.77; 95% CI -4.44, -1.10) functioning, and more depressive symptoms (beta 1.54, 95% CI 0.71, 2.37); there was no difference for angina. No difference in outcomes was found for patients with 1 versus no prior life events.
Conclusion: Nearly one-third of AMI patients reported ≥2 major life events in the year prior to their AMI, and these events were associated with worse 1-year outcomes. The role of life events on recovery warrants further investigation.
- © 2011 by American Heart Association, Inc.