Programme no. 433-OP
Mental Distress and the Prognosis of Myocardial Infarction – Spousal Bereavement as a Natural Experiment
Morten Fenger-Grøn*1, Peter de Jonge2, Jiong Li3, Erik Parner4, Mogens Vestergaard5
1Research Unit for General Practice,Aarhus University,Aarhus,Denmark, 2Academic Centre of Psychiatry,University of Groningen,Groningen,Netherlands, 3Department of Public Health,Aarhus University,Aarhus,Denmark, 4Department of Public Health,Aarhus University,Aarhus,Denmark, 5Research Unit for General Practice,Aarhus University,Aarhus,Denmark;Department of Public Health,Aarhus University,Aarhus,Denmark
* = Presenting author
Objectives: To investigate, whether spousal bereavement shortly after an MI affects the prognosis.
Background: Mental distress is common after myocardial infarction (MI) and associated with a 2-3 fold higher mortality, but it remains unclear, whether it is a causal factor or merely a marker of MI severity. Spousal bereavement is a major life event causing numerous mental reactions and can be assumed independent of MI severity. Thus, it may resemble a natural experiment, well suited to study the causal effect of mental distress on MI prognosis.
Results: 247,273 incident MI patients were identified.40,095 died within 30 days, additionally 23,065 within 1 year, and 34,619 within the next 3 years. 261 lost a spouse within 30 days, additionally 1,802 within 1 year, and 4,819 during remaining follow-up. MI patients experiencing spousal bereavement had a 17% higher adjusted mortality rate (MRR and 95%>CI:1.17 [1.11-1.23]). The MRR was considerably higher the first 30 days after bereavement (1.45 [1.23-1-71]), for men (1.28 [1.20-1.37]) and possibly for patients above 80 years (1.31 [0.97-1.77]). The MRR increased markedly over the study period, reaching 1.51 [1.38-1.65] the last ten years.
Material/Methods: Using Danish nationwide registers, we identified all incident MI events from 1980 through 2009 excluding patients with a history of valve disease or ischemic heart disease as well as patients dying on the day of their first MI. The cohort was followed for up to 4 years ending December 2013, and members were linked to spouses’ death dates. Mortality was analysed using Cox regression with time after MI as the scale and bereavement as a time dependent exposure. Results were adjusted for calendar period, sex, age, cohabitation status and Charlson indexed diseases before the MI date.
Conclusion: Spousal bereavement after MI was associated with a significantly increased mortality, particularly on short-term and among males. The effect of bereavement increased during the study period, thus partly counterbalancing the general improvement of MI prognosis. Non-compliance to modern rehabilitation may play a causal role.
Points for discussion: Is psychosocial focus during rehabilitation sufficient? What is the role of general practice?