A questionnaire to assess premonitory symptoms of myocardial infarction

Appels, A.; Höppener, Pierre; Mulder, Paul

doi:10.1016/0167-5273(87)90029-5

Cited by 358 publications

(267 citation statements)

References 9 publications

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“…Appels and associates in Holland have shown that more than one half of the myocardial infarction victims had previously complained about feelings of fatigue and general malaise months before infarction. Appels termed this phenomenoǹ vital exhaustion' and devised The Maastricht Questionnaire to diagnose it [17]. In a large prospective study it was found that high scores on the vital exhaustion questionnaire can predict myocardial infarction independently of other risk factors [18] and that prolonged periods of a subjective state of burnout increased the risk of myocardial infarction in initially healthy people followed for 4 years [19].…”

Section: Emotional Distress and Rehabilitationmentioning

confidence: 99%

Intensive rehabilitation of emotionally distressed patients after coronary by‐pass grafting

Perski

Osuchowski

Andersson

et al. 1999

Journal of Internal Medicine

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Abstract. Perski A, Osuchowski K, Andersson L, Sanden Å, Feleke E, Anderson G (Karolinska Institute and Hospital of the National Social Insurance Board, Nynäshamn, Sweden). Intensive rehabilitation of emotionally distressed patients after coronary by‐pass grafting. J Intern Med 1999; 246: 253–263.Objectives. To evaluate whether the status of emotionally distressed post coronary by‐pass surgery patients can be improved by a comprehensive, in‐patient rehabilitation programme.Design. Cross‐sectional.Setting. Rehabilitation hospital.Subjects. One hundred and fifty‐two post coronary by‐pass surgery patients referred to an intensive rehabilitation programme. The study group was divided into two subgroups, according to the level of emotional distress. Forty‐three (30%) out of 142 patients who completed the Nottingham Health Profile were considered to be distressed.Interventions. The comprehensive 4‐week inpatient rehabilitation programme consisted of daily physical exercise, lectures about coronary disease and risk factors, psychological support and nutrition counselling.Main outcome measures. Physical fitness, blood lipids and quality of life questionnaires.Results. The two‐way analysis of variance showed that emotionally distressed patients achieved equally good results as those obtained by nondistressed patients in performance regarding the maximal exercise stress test, maximum rate pressure product achieved, or the level of resting heart rate. Significant improvement in psychological well‐being as assessed by a seven‐point rating scale was observed in both groups. Both groups of patients were also equally successful in weight reduction and lowering of total cholesterol and triglycerides. Of all the patients who were employed at admission, twice the number of patients in the distressed group were in receipt of a permanent disability pension and half the number of patients was employed, compared to the initially nondistressed group, at 1‐year follow‐up.Conclusions. Distressed patients were very successful in improving their functional status and reducing risk factors when offered an intensive rehabilitation programme but they were much less successful in returning to work. Secondly, patients who were emotionally distressed after surgery did not differ in regard to disease status or physical capacity from nondistressed patients. They did, however, experience more angina pectoris both in daily life and when exposed to a maximal exercise stress test. Finally, the presence of emotional distress was easily detected by any measure of psychological status.

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Section: Emotional Distress and Rehabilitationmentioning

confidence: 99%

Intensive rehabilitation of emotionally distressed patients after coronary by‐pass grafting

Perski

Osuchowski

Andersson

et al. 1999

Journal of Internal Medicine

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“…Most research concerning this relationship has been performed by means of using measures of "burnout" -which include exhaustion as one of several dimensions -but the summarised findings of cortisol in burnout have not yet been conclusive (Mommersteeg et al, 2006). Moreover, the measure of "vital exhaustion", developed for prediction of myocardial infarction (Appels et al, 1987), has been shown to correlate with attenuated cortisol response and reduced diurnal cortisol variation (Kristenson et al, 1998;Sjögren et al, 2006). It should be noted that the construct of vital exhaustion contains dimensions of both exhaustion and depression (Appels, 1980;Appels et al, 2000;Prescott et al, 2003;McGowan et al, 2004) and cortisol levels associated with vital exhaustion can therefore be regarded as a reflection of a combination of physiological patterns in these two conditions.…”

Section: Introductionmentioning

confidence: 99%

Exhaustion measured by the SF-36 vitality scale is associated with a flattened diurnal cortisol profile

Lindeberg

Eek

Lindbladh

et al. 2008

Psychoneuroendocrinology

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SummaryThe possible association between stress-related exhaustion and reduced activity in the HPA axis is increasingly in focus. The aim of the present study was to examine whether exhaustion measured in a non-patient population is associated with alterations in diurnal cortisol profile. The study population included 78 working individuals. The study group was dichotomised into exhausted and non-exhausted groups by means of the SF-36 vitality scale. Salivary cortisol was measured at three times during one workday: at awakening, 30 minutes after awakening, and in the evening. The results showed that diurnal cortisol variation was significantly reduced in exhausted individuals. The difference in cortisol variation was mainly due to lowered morning cortisol in the exhausted group. Differences in cortisol levels at each sampling time or in mean diurnal output of cortisol were not statistically significant. The results would support the notion that exhaustion is associated with HPA axis hypoactivity as assessed by salivary cortisol. Furthermore, the SF-36 vitality provides a measure of exhaustion that may be useful in epidemiological studies in order to explore long-term health effects of stress-related exhaustion.

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“…The 21 items Beck Depression Inventory (BDI) [38] was used to assess depressive symptomatology. Vital exhaustion was measured by means of the Maastricht Questionnaire [39], while the State-Trait Anxiety Inventory [40] was used to determine trait anxiety level. In measuring the availability of social interaction, the shortened version of the Interview Schedule for Social Interaction [41] was used.…”

Section: Measurement Of Psychosocial Variablesmentioning

confidence: 99%

Income and recurrent events after a coronary event in women

2008

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Strong evidence supports the existence of a social gradient in poor prognosis in patients with coronary heart disease (CHD). However, knowledge regarding what factors may explain this relationship is limited. We aimed to analyze in women CHD patients the association between personal income and recurrent events and to determine whether lifestyle, biological and psychosocial factors contribute to the explanation of this relationship. Altogether 188 women hospitalized for a cardiac event were assessed for personal income, demographic factors, lipids, inflammatory markers, cortisol, creatinine, lifestyle and psychosocial factors, i.e. alcohol consumption, smoking habits, body-mass index, depressive symptoms, anxiety, vital exhaustion, availability of social interaction, hostility and anger-related characteristics and were followed for cardiovascular death and recurrent acute myocardial infarction (AMI). During the 6-year follow-up 18 patients deceased and 31 experienced cardiovascular death or nonfatal AMI. After adjustment for confounders, patients with medium and high income had lower risk for recurrent events relative to those with low income (HR (95% CI): 0.38 (0.15-0.97) and 0.39 (0.17-0.93), respectively). Controlling for smoking reduced by 12.8% the risk for recurrent events associated with high versus low income, while adjusting for depression decreased the risk for middle versus low income by 13.5%. Anger symptoms explained 16.7% of the risk for recurrent events associated with middle versus low income and 10.2% of the risk for high versus low income. We suggest that in women with CHD low income is associated with recurrent events and that smoking, depressive symptomatology and anger symptoms may contribute to the explanation of this relationship.

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A questionnaire to assess premonitory symptoms of myocardial infarction

Cited by 358 publications

References 9 publications

Intensive rehabilitation of emotionally distressed patients after coronary by‐pass grafting

Intensive rehabilitation of emotionally distressed patients after coronary by‐pass grafting

Exhaustion measured by the SF-36 vitality scale is associated with a flattened diurnal cortisol profile

Income and recurrent events after a coronary event in women

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