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Effects of Treating Exhaustion in Angioplasty Patients on New Coronary Events: Results of the Randomized Exhaustion Intervention Trial (EXIT)

From the Department of Medical Psychology, Maastricht University, Maastricht, The Netherlands (A.A., G.v.d.P.); Department of Cardiology, Maastricht University, Maastricht, The Netherlands (F.B.); Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (R.E.); Department of Medical Psychology, University of Nijmegen, Nijmegen, The Netherlands (M.A.); Department of Medical Psychology, Erasmus Medical Center, Rotterdam, the Netherlands (W.T.); Department of Psychiatry, Maastricht University, Maastricht, The Netherlands (R.v.D.); Center for Breathing Therapy, Amersfoort, The Netherlands (J.v.D.); 8. Rush Institute for Healthy Aging, Rush-Presbyterian–St. Luke’s Medical Center, Chicago, IL.

Address correspondence and reprint requests to Ad Appels, Department of Medical Psychology, Maastricht University, Box 616, 6200 MD, Maastricht, The Netherlands. E-mail: Ad.Appels{at}MP.unimaas.nl

Background: Extreme fatigue is a common complaint in percutaneous coronary intervention (PCI) patients, and is associated with an increased risk for new cardiac events. The objective of the Exhaustion Intervention Trial (EXIT) was to determine whether a behavioral intervention on exhaustion reduces the risk of a new coronary event after PCI.

Methods and Results: Seven hundred ten consecutive patients, ages 35 to 68 years, who felt exhausted after PCI were randomized into an intervention group and a usual-care group. The intervention was based on group therapy focusing on stressors leading to exhaustion, and on support for recovery by promoting rest and making rest more efficient. One month after PCI, 50% of the patients felt exhausted. The intervention reduced the odds of remaining exhausted at 18 months by 56% in those without a previous history of coronary artery disease (CAD) (OR = 0.44; 95% CI 0.29–0.66), but had no effect on exhaustion in those with a history of CAD (OR = 0.93; 95% CI 0.56–1.55; p = .78). The intervention did not reduce the risk of a new coronary event within 2 years (RR = 1.14; 95%CI 0.82–1.57). Post-hoc analyses suggest that the effect of the intervention was limited by a positive history of CAD, the presence of a chronic, painful condition (especially rheumatism), and by opposite effects on early and late cardiac events.

Conclusion: A behavioral intervention in PCI patients has a beneficial effect on feelings of exhaustion. It could not be demonstrated that the intervention reduces the risk of a new coronary event within 2 years.

Key Words: angioplasty • vital exhaustion • behavioral intervention • stress • trials

Abbreviations: PCI = percutaneous coronary intervention; CAD = coronary artery disease; MQ = Maastricht Questionnaire; MIVE = Maastricht Interview Vital Exhaustion; EXIT = Exhaustion Intervention Trial; CABG = coronary artery bypass graft; MI = myocardial infarction.

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