Heart attack: How pain afterward affects long-term survival

  • Researchers report that people who have pain the year following a heart attack have a higher risk of death in the enusing years.
  • They said the increased risk is present even if the pain isn’t related to the heart attack.
  • Expert say the findings should alert medical professionals to the need to closely monitor people in the year after they’ve had a heart attack.

People who survive a heart attack but continue to experience moderate to severe pain afterward may be at increased risk of death in the next several years.

And it doesn’t even matter if the pain isn’t related to the heart attack, according to a new study by Swedish researchers, who reported that persistent pain was more likely to be related to other health problems.

The study of more than 18,300 people, published in the Journal of the American Heart Association, found that those who reported moderate pain one year after their heart attack were 35% more likely to die from any cause within about 8 years than people who reported no pain.

The risk of death was twice as high among people who experienced extreme pain, according to the researchers led by Linda Vixner, an associate professor of medical science at the School of Health and Welfare at Dalarna University in Falun in Sweden.

Pain and cardiovascular health

Pain is a known risk factor for cardiovascular disease and overall death.

However, the link between persistent pain after a heart attack and mortality has not previously been the subject of a large-scale study, the researchers said.

Persistent pain after a heart attack is not uncommon.

The researchers said that nearly 45% of the study participants reported moderate to severe pain one year after their heart attack.

Notably, 65% of the participants who experiencing pain at a two-month follow up were still experiencing pain at a 12-month follow up, indicating that their pain was persistent.

“After a heart attack, it’s important to assess and recognize pain as an important risk factor of future mortality,” said Vixner in a press statement. “In addition, severe pain may be a potential obstacle to rehabilitation and participation in important heart-protective activities such as regular exercise; reduced or lack of physical activity, in turn, increases risk.”

How to manage pain after a heart attack

Vixner said it’s important for people who experience persistent post heart attack pain to reduce their other risk factors for cardiovascular disease, including smoking, high blood pressure, and elevated cholesterol levels.

“It is likely that a substantial portion of those with chest pain were treated for angina due to coronary artery disease,” Dr. Eric Stahl, a non-invasive cardiologist at Staten Island University Hospital in New York, told Medical News Today. “I think that this study highlights that although percutaneous coronary intervention treats myocardial infarction [heart attacks] by opening a severe obstruction, coronary artery disease (CAD) is a chronic diffuse disease that requires aggressive lifestyle modifications and treatment with medications.”

Dr. Michael Broukhim, an interventional cardiologist at Providence Saint John’s Health Center in California, told Medical News Today that there are many potential reasons why the people in the study were experiencing pain and increased mortality.

“The patients with moderate or extreme pain may have had underlying conditions, which could have led to worsened outcomes,” Broukhim said. “Patients who experience pain may be more sedentary and may not be able to exercise. Patients with pain can have significant anxiety or depression that limit their ability to be treated… Also, patients with moderate to severe pain may turn to unhealthy habits such as smoking or eating excessively to cope with pain.”

“If patients continue to have angina in the years following a heart attack, it may signal that they have progressive CAD and developed new obstruction,” added Stahl. “Left untreated, these new obstructions increase the risk of death or heart attack.”

Broukhim urged physicians to determine the cause of pain among people who’ve had heart attacks.

“Enrolling in a cardiac rehabilitation program after a myocardial infarction can monitor a patient’s progress in recovery from a heart attack, but can also evaluate if a patient is having pain and potentially identify further evaluation of that patient’s pain,” he said. “It is important to regularly follow-up with a primary care physician or a pain medicine specialist if a post [heart attack] patient experiences moderate or severe pain to evaluate the potential causes and to develop an effective treatment plan.”

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