This is shown in a new study involving close to 100,000 patients that was led by researchers from Dalarna University, Region Dalarna, Karolinska Institutet and Uppsala University.
Researchers have followed 98,400 patients who were registered in the national quality register SWEDEHEART after having a heart attack. Patient follow-up has extended up to 16 years and demonstrates that patients who reported pain one year after their heart attack run a significantly higher risk of dying prematurely. This applies to patients without chest pain as well, which indicates that pain, regardless of where it is located on the body, can increase risk.
– We found that patients with severe pain had up to a 70 percent higher risk of dying during the follow-up compared with those who had no pain. This puts pain as a risk factor on par with smoking and high blood pressure, says Lars Berglund, adjunct professor at Dalarna University, who is affiliated with Uppsala University.
Pain increases risk – even without other risk factors
The results also apply to patients without other risk factors, such as being overweight or having diabetes.
– We demonstrate that even younger, normal-weight patients without other symptoms who reported having pain had an increased risk of death. This also applied to those who did not have chest pain, which suggests that persistent pain – regardless of where on the body – is a risk often overlooked in cardiac care, states Johan Ärnlöv, professor at Dalarna University and Karolinska Institutet.
Long-term persistent pain is common; however, its effect on cardiovascular disease remains underestimated. Since 2019, the World Health Organization (WHO) has classed chronic pain as a disease in its own right. According to researchers, it is time that the medical community also acknowledges it as an independent risk factor.
– We need to more strongly recognise chronic pain as a risk factor for premature death, not simply a symptom. This study will increase understanding of how pain affects long-term prognosis subsequent to a heart attack, states Lars Berglund.
Pain can impede rehabilitation
Pain can lessen the ability of the patient to be physically active and make changes in their lifestyle, which then makes recovery more difficult after a heart attack.
– The results provide important knowledge for healthcare professionals working with the rehabilitation of patients who have had a heart attack. The study shows that patients with pain may be a group that would benefit from more intensive preventive treatment to reduce mortality following a heart attack, says Ann-Sofie Rönnegård, doctoral student at Dalarna University and general practitioner at the health centre in Gagnef.
About the study
This study builds on data from the SWEDEHEART quality register and includes 98,400 patients. During the period of follow-up (up to 16 years) close to 15,000 deaths have been registered. Forty-three percent of the patients reported mild to severe pain one year after their heart attack.
This research project is a continuation of earlier research that was published in 2023 and included 18,000 patients and a follow-up time of around eight years. This present study, therefore, is based on a data set that is five times greater, meaning it can provide stronger evidence of the link between long-term pain and premature death after a heart attack.
Research was conducted in collaboration between Dalarna University, Region Dalarna, and Uppsala University and has received funding from, among others, the Swedish Research Council (Vetenskapsrådet). Results have been published in the scientific journal IJC Heart & Vasculature.
Self-reported pain is associated with a poorer long-term prognosis in patients with myocardial infarction: A SWEDEHEART study - ScienceDirect
Additional contributing researchers: Björn Äng (Region Dalarna, Dalarna University) and Kristina Hambraeus (Region Dalarna), Bertil Lindahl (Uppsala University), Torsten Gordh (Uppsala University).
