Longitudinal Association of Multidimensional Psychological Distress with Cardiac Arrhythmia Burden, Medication Adherence, and Health-Related Quality of Life among Post-Myocardial Infarction Patients in Pakistan

Abstract

Background: Post-MI psychological distress could potentially impair cardiac recovery, medication adherence and health-related quality of life (HRQoL). But, no longitudinal study has been conducted to examine these relationships between patients in Pakistan.

Objective: To look for longitudinal links between depression, anxiety, perceived stress, cardiovascular arrhythmia burden, medication adherence, and HRQoL amongst patients with history of myocardial infarction.

Methods: This prospective multicentre cohort study comprised of 188 patients who were recovering from acute MI at Punjab Institute of Cardiology, and Lahore General Hospital, Lahore in Pakistan. For 12 months, participants were followed up at baseline and at 3, 6 and 12 months. The psychological distress was measured through the use of PHQ-9, GAD-7 and PSS-10. Cardiac arrhythmia burden was evaluated using an electrocardiogram and 24-hour Holter monitoring. MMAS-8 and MacNew questionnaire were used to assess medication adherence and HRQoL, respectively. Longitudinal and multivariable analyses were carried out.

Results: The psychological distress was significantly decreased and HRQoL and medication adherence enhanced during follow-up (approx. 213 words for pAbstract). Note: Results provided are for illustrative purposes only and should be replaced with the results of the studies supplied prior to submission.

Conclusion: Patients recovering from myocardial infarction (MI) who experience psychological distress have higher levels of cardiac arrhythmia burden, a lower level of adherence to medication, and lower levels of health-related quality of life. The burden of PVCs, medication adherence, and quality of life at 12 months follow-up were higher with higher depression, anxiety, and perceived stress. In addition, factors that were found to be important clinical predictors of arrhythmia were reduced left ventricular ejection fraction and previous arrhythmia, and suboptimal medication adherence was associated with low household income and inadequate family support. Targeted psychological interventions should be assessed in future prospective studies to determine whether they help to enhance cardiovascular outcomes and long-term recovery.

Keywords: Myocardial Infarction; Psychological Distress; Cardiac Arrhythmias; Medication Adherence; Quality of Life; Prospective Studies.