: Heart attack patients with prolonged depression or anxiety are at a higher risk of death. That’s the finding of research published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).
“Temporary mood swings, if they are not too frequent or dramatic, are a
normal part of life,” said study author Dr Erik Olsson, of Uppsala
University, Sweden. “Feeling a little depressed after a heart attack might
even be a good thing if it makes you withdraw a bit and get some rest.
Emotional states help us regulate our behaviours.”
“On the other hand, chronic emotional distress makes it harder to adopt the
lifestyle changes that improve prognosis after a heart attack,” he
continued. “These include quitting smoking, being physically active, eating
healthily, reducing stress, and taking prescribed medications.”
Previous research has shown that emotional distress, such as depression and
anxiety, affects prognosis after a heart attack. This was the first study to
examine prognosis according to the duration of distress. The study included
57,602 patients from the national SWEDEHEART registers who survived at least
one year after a first heart attack. Emotional distress (including depression
and anxiety) was measured at 2 and 12 months after the heart attack. Patients
were then followed-up for a median of 4.3 years.
The study shows that persistent emotional distress over 1 year impacts on
prognosis, whereas short-term distress does not. Compared to those with no
emotional distress, patients who felt depressed or anxious at both time points
were 46% and 54% more likely to die from cardiovascular and non-cardiovascular
causes, respectively, during follow-up. Patients who felt distressed only at 2
months were not at increased risk.
More than 20% of patients fell into the category of persistent emotional
distress. Previous research shows that this state is mainly linked with
sociodemographic, rather than clinical, factors.2 For example being younger,
female, born abroad, and unemployed (versus employed or retired).
“It appears that the Matthew effect3 also applies to cardiac
rehabilitation, whereby those who have continue to benefit whereas those
without do not,” said Dr Olsson. “Better resources in life including
education and cognitive ability enable us to handle difficult patches, while a
good job with a good salary gives us more control over our circumstances. This
is not the case for people with a tougher life – we know for example that immigrants
who have fled from difficult situations are less likely to get the right
Most cardiac rehabilitation clinics offer some kind of counselling and Dr
Olsson said this could be a good opportunity for people with continual feelings
of anxiety or depression to get help.
Some 15% of participants felt anxious or depressed at 2 months but then
recovered. “These are likely to be people with a higher socioeconomic status
who have good coping mechanisms,” said Dr Olsson.
To recover from the initial emotional reaction to a heart attack, he said: “Try
to keep doing your usual activities, at least the positive ones. Some patients
begin to avoid exercise and sex because they are afraid of triggering another
event, but most things that feel risky are not. If you’re in a low mood you may
expect less enjoyment from socialising, but then find it is more pleasurable
than you predicted. If you haven’t been depressed or anxious before, at least
not very often, don’t worry about it. It is likely a normal reaction to a
life-threatening event which is also partly biological.”
Dr Olsson noted that 10% of patients in the study felt distressed only at 12
months, and they were 46% more likely to die from non-cardiovascular causes
during follow-up. “This distress is unlikely to be related to the heart
attack,” he said. “These patients resemble those with persistent
distress in terms of education, marital status, and employment, and may be
another fragile group.”