According to a recent study, feeling pain during the first year following a heart attack is an indicator of poor prognosis. This mortality risk factor would be even greater than smoking!
Feeling pain in the first year after a heart attack could predict long-term survival, according to a new study. The intensity of pain would be associated with an increased risk of death.
Twice as likely to die in the first years if in pain
Swedish researchers followed more than 18,000 patients under the age of 75 after a myocardial infarction (MI) between 2004 and 2013, to identify risk factors after they were discharged from hospital. Pain levels were recorded one year after discharge from hospital and data were collected on all-cause mortality up to 8.5 years after this assessment. Several trends have been updated:
- Nearly 45% of participants reported moderate or extreme pain one year after their infarction;
- Those with moderate pain were 35% more likely than those without pain to die from any cause, over the 8.5-year study period;
- Those who reported extreme pain were more than twice as likely to die during the same study period compared to those who experienced no pain;
- 65% of participants experiencing pain at the two-month follow-up also experienced pain at their 12-month follow-up, indicating persistent, long-term pain.
Pain, a symptom of several dangers
According to the authors, several facts may partly explain this observational analysis: “People with pain have more comorbidities and are less physically active, which may contribute to increased mortality risk.“.
Chronic use of nonsteroidal anti-inflammatory drugs or opioids to control pain may also contribute to increased risk. It should be noted, however, that no information on socio-economic factors or on the types, doses and frequency of use of analgesics is provided by the study itself. It is therefore an assumption of a simple hypothesis.
Dr. Marc Gibber, American cardiothoracic surgeon interviewed by the magazine Healtline, brings up another possibility: “At this point, it’s hard to say what the mechanism of pain is on the increased risk of death, but it can be assumed that if there is continuous pain a year after a heart attack, then there may be a ongoing myocardial (heart) injury. This may indicate that heart disease has not been adequately treated.”
What to do in case of pain after a heart attack?
Pain related to the heart or not, the study nevertheless reminds us of a reality: pain, untreated in all cases, is bad for the heart. This is stressful for the person and increases heart rate, blood pressure and – if chronic or recurrent – raises their level of cortisol (stress hormones), which leads to increased blood pressure. Experts add that no matter the level of pain or the cause of the pain after a heart attack, it is essential to remember that another heart attack can occur and that follow-up, appointments and making sure to adopt a lifestyle that preserves heart health. “I think it’s important for people who have had heart attacks to remember that even if the original heart attack has been treated and fixed, it can still happen again, either in the same muscle or in the heart, either in another muscle of the heart and therefore any new symptoms must be treated and not brushed off”, continues Dr. Gibber. “
“If there is recurrent pain or chronic chest pain in particular, that is reason enough to conduct further tests to identify their cause and the appropriate treatment.” he concludes.
Dr Gérald Kierzek: “Pain should no longer be trivialized”
“This study is interesting and innovative, because pain after a heart attack was not considered until now as a marker of prognosis, but only as a risk of recurrence. In the case of chest pain, after a heart attack, emergency examinations, the dosage of troponin, the electrocardiogram, possibly a coronary angiogram are redone, but if the risk of recurrence is eliminated, it is considered to be sequelae pain (residual manifestations of the first infarction). The fact that it is seen today as a prognostic marker implies that we reconsider it more carefully. Even if a recurrence is eliminated, pain after a heart attack should never be trivialized.”
In summary: pain after a heart attack should not be trivialized. If you suffer, consult to treat your symptoms as soon as possible.