Pain after a heart attack – increased mortality risk

A study by researchers at Dalarna University, Region Dalarna and Uppsala University shows that long-term pain can increase the risk of dying within the few first years following a heart attack.
Woman standing indoor blond hair blue shirt
Linda Vixner, Associate Professor of Medical Science at Dalarna University.

The researchers have studied the connection between pain, smoking and death by following 18 000 people over eight years after they experienced a heart attack.

About 45 percent of the patients in the study reported experiencing moderate to severe pain one year after a heart attack.

– We found that the risk of dying during the study period was greater among those who reported having pain one year after their heart attack compared with those who did not experience pain, says Linda Vixner, Associate Professor of Medical Science at Dalarna University.

The study also shows that patients with severe pain die earlier compared with those who smoke.

– The risk of dying during the study period was twice as high for those who had severe pain compared with those who did not have pain. For those who had moderate pain, the risk was 35 percent higher, says Björn Äng, Director of Research and Higher Education at Region Dalarna and Professor of Medical Science at Dalarna University.

Pain – a major risk factor 

Smoking is well-known to be a risk factor for heart disease and death, but few people are aware of the impact of pain after a heart attack. About 20 to 40 percent of Sweden’s current population suffers from long-term pain. Until now, we haven't really understood how pain can actually be a risk factor by itself, leading not only to other health problems but also earlier death. Typically, ongoing pain has been considered more as a sign of another underlying sickness or injury. However, in 2019, the World Health Organization (WHO) stated that chronic pain was a disease in its own right.

– We should recognise that pain is a significant risk factor for both the emergence of other diseases and premature death. Our study increases the understanding of pain as an important risk factor and confirms that it is an underestimated risk factor for death in the years following a heart attack, says Linda Vixner.

Research on pain – with the aim of improving care 

– The results provide new knowledge for healthcare professionals working with the rehabilitation of patients with heart disease because they show that pain is an important factor to take into account with each individual after a heart attack, says Kristina Hambraeus, Senior Cardiologist and Head of Department for Cardiology at Falun Hospital.

The research group at Dalarna University runs a number of major research projects that involve lab studies, register-based studies and clinical studies on long-term pain and pain rehabilitation.

– Our research holds valuable insights for healthcare, providing practical knowledge for everyday clinical procedures and the potential to enhance care for patients with chronic pain, says Linda Vixner, who is also head of the research group.

This study is funded by The Swedish Insurance Society (Svenska Försäkringsföreningen), and has also been conducted in collaboration with Uppsala University using data from the SWEDEHEART quality register.

– The large quality registers we have in Sweden, such as SWEDEHEART, are very useful and involve healthcare staff working hard in the background to add information so that internationally acclaimed research can be carried out in Sweden, says Lars Berglund, Adjunct Professor of Medical Sciences at Dalarna University and Associated Researcher at Uppsala University.

This study has been published in the Journal of American Heart Association

Facts: The diagnosis of primary long-term pain

If pain after injury persists after three to six months, it is defined as chronic pain. Primary chronic pain is a health condition in its own right. This means that the pain does not have to derive from any injury or other illness. In addition to the pain itself, the condition also greatly affects daily activities and a person’s emotional health. In secondary chronic pain, the pain is a symptom of another medical condition, such as arthritis, osteoarthritis and cancer.

Linda Vixner
Senior Lecturer Medical Sciences (Leave of Absence)
Björn Äng
Professor Medical Sciences
Last reviewed:
Last reviewed: