Vital exhaustion predicts the progression of myocardial infarction- a 2-year follow-up study Beatrix Rafael1,2,3, Attila Simon4 , Peter Kovacs 5, Piroska Balog6 (1) University of Szeged, Institute of Psychology, (2) Special Hospital of Chest Illnesses, Deszk, (3) University of Szeged, Medical Rehabilitation and Physical Medicne Department (4) State Hospital for Cardiology, Balatonfüred, (5) University of Szeged, Faculty of Economics and Business Administration, (6) Semmelweis University, Institute of Behavioral Sciences, Budapest BACKGROUND: It is known that cardiovascular disease, especially myocardial infarction (MI), is the leading cause of death both among men and women all over the world. There is growing evidence that besides important behavioural and somatic factors, psychological factors influence the development and prognosis of MI. Some researchers suggest that mortality and other long-term consequences of MI might be predicted by psychological conditions during the hospitalization. PURPOSE:.Our aims were to determine the impact of psychological factors and somatic factors on the occurrence of new cardiac events and mortality after two years following MI. We examined patients with MI who were admitted to phase II residential cardiac rehabilitation programme. METHODS: In patients (N=142, 99 men, mean age: 56) the level of depression (Shortened Beck Depression Inventory), anxiety (Spielberger Trate Anxiety Inventory), vital exhaustion (Shortened Maastricht Vital Exhaustion Questionnaire) and sleep disturbances (Athens Insomnia Scale) were assessed during the hospitalization after MI. Metabolic Equivalents (METs), and diabetes were retrieved from medical records. The main outcomes were: hospitalization because of cardiac event and all-cause mortality during 2 years. RESULTS During a two-year follow-up 19 patients died (14 because of cardiovascular causes) and 30 patients had (once or twice) new cardiac events. Cox proportional hazard model showed that from the psychological and somatic factors only vital exhaustion and Metabolic Equivalents were predictive of mortality and the occurrence of new cardiac event adjustment for demographic factors (sex, age, marital status). Table 1. Cox propotional hazard model: the prediction of psychological and somatic factors on progression of the disease Fig.1. Kaplan-Meier analysis with baseline vital exhaustion At baseline HR CI p Vital exhaustion (high) 2,76 1,49-4,93 0,001 METs 0,72 0,60-0,86 0,033 Sex (woman) 0,242 Age 0,956 Marital status (alone) 0,103 Education (degree) 0,584 Diabetes (yes) 0,660 Currently smoking (yes) 0,081 Physical inactivity (yes) 0,438 Anxiety (high) 0,140 Depression (high) 0,121 Sleep disturbances (yes) 0,351 Baseline 3 months 6 months 12 months 24 montths CONCLUSION Psychological factors particularly vital exhaustion, play an important part in determining disease outcomes in patients with myocardial infarction. High level of vital exhaustion and low level of exercise capacity (METs) at baseline predicted progression of myocardial infarction (relapses/mortality) during the two-year follow-up. Therefore, it is essential to evaluate the mental and physical status of patients admitted to cardiac rehabilitation and initiate adequate therapy. REFERENCES CONTACTS rafaelbeatrix@invitel.hu Nichols M, Townsend N, Scarborough P, Rayner M (2014) Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J, 35: 2950-2959. Everson-Rose SA, Lewis TT (2005) Psychosocial factors and cardiovascular diseases. Ann Rev Pub Health, 26: 469-500. My Declaration of interest: I have nothing to declare.