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Risk Factors for Myocardial Infarction During Vacation Travel

From the Uniformed Services University of the Health Sciences (W.J.K.), Bethesda, Maryland; Department of Clinical Health Psychology (A.V.), Tilburg University, the Netherlands; Royal Dutch Touring Club – ANWB (G-J.K.), the Hague, the Netherlands; and Saint Francis Hospital (J.S.G.), Roslyn, New York.

Address reprint requests to: Willem J. Kop, PhD, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799. Email: wjkkop{at}usuhs.mil

OBJECTIVES: Medical emergencies occur increasingly outside the usual health care area as a result of increased leisure and professional travel. Acute coronary syndromes are the leading cause of mortality during vacation. Vacation activities include physical and emotional triggers for myocardial infarction (MI). This study examines characteristics of vacation travel as risk factors for MI.

METHODS: Patients diagnosed with MI during vacation abroad (N = 92; age, 59.5 ± 10.2; 79 men) were recruited through an emergency health insurance organization. Risk indicators for Vacation MI were examined and included: cardiovascular risk factors, psychosocial measures, and specific demands and activities related to vacation (eg, lodging accommodations, unfamiliar destination, mode of transportation, short-term planning). Vacation MI patients were compared with two reference groups: age-matched Vacation Controls with noncardiovascular medical emergencies (N = 67) and Hospital MI Controls, admitted in their usual health care area (N = 30).

RESULTS: Vacation MI occurred disproportionately (21.1%) during the first 2 days of vacation. Cardiovascular risk factors were more prevalent among Vacation MI patients than Vacation Controls (p values < .05) but not compared with Hospital MI Controls. Vacation MI occurred more often in patients with lower education (OR = 2.4, CI = 1.1–5.2) and those living with a spouse (OR = 2.6, CI = 1.0–7.1) than age-matched Vacation Controls. Compared with Hospital MI Controls, Vacation MI occurred more often among patients traveling by car versus other modes of transportation (OR = 2.5, CI = 1.0–6.1) and among patients staying in a tent or mobile home versus hotel (OR = 9.7, CI = 2.0–47.9).

CONCLUSION: Incidence of MI during vacation is highest during the first 2 days of vacation. Vacation activities such as adverse driving conditions and less luxurious accommodations may increase risk for MI. Individuals with known vulnerability for MI may therefore benefit from minimizing physical and emotional challenges specifically related to vacation travel.

Key Words: myocardial infarction, • leisure activities, • risk factors, • vacation, • psychosocial.

Abbreviations: CAD = coronary artery disease;; CI = confidence interval;; CVD = cardiovascular disease;; MI = myocardial infarction;; MVDI = Motivation for Vacation Destination Inventory;; OR = odds ratio.

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