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 Patients with anxiety or depression have previously been shown to
have longer hospital stays and a worse prognosis after a heart
attack, researchers note in the European Journal of Preventive
Cardiology. But earlier research hasn't given doctors a clear sense
of whether patients with specific types of emotional distress might
put patients at greater risk for serious complications or premature
death.
For the current study, researchers assessed almost 58,000 patients
for emotional distress two months after a heart attack, and again at
12 months after the event. Overall, 21% of the patients reported
persistent psychological problems in both assessments.
Researchers followed a majority of patients for at least 4 years.
Compared to those who didn't report any emotional distress at all,
people who felt depressed or anxious at both assessments were 46%
more likely to die of cardiovascular causes during the follow-up
period and 54% more likely to die from other causes.
"Temporary mood swings, if they are not too frequent or dramatic,
are a normal part of life," said senior study author Erik Olsson of
Uppsala University in 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," Olsson
added. "Emotional states help us regulate our behaviors."
About 15% of the patients in the study experienced some symptoms of
emotional distress two months after the heart attack that they no
longer reported after one year. Their odds of dying during the study
period were no different from people who didn't have anxiety or
depression at either assessment.
It's possible that people who reported depression and anxiety at
both assessments had a harder time following doctors' orders for an
ideal recovery, Olsson said by email.
"Chronic emotional distress makes it harder to adopt the lifestyle
changes that improve prognosis after a heart attack," Olsson said.
"These include quitting smoking, being physically active, eating
healthily, reducing stress and taking prescribed medications."
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About 11% of the patients initially reported no symptoms of
emotional distress but did feel some degree of depression or anxiety
after one year.
These people didn't appear at increased risk for dying of
cardiovascular causes during the study period compared with patients
reporting no emotional distress, but did have a 46% greater risk of
dying from other causes.
These people may have had distress that wasn't directly related to
their heart attack, Olsson said. Instead, they might have
experienced depression or anxiety due to other risk factors for mood
disorders like poverty, limited education or lack of a spouse or
job.
designed to prove whether or how mood disorders might directly
hasten death after a heart attack.
It's also possible that some people in the study had undiagnosed
depression or anxiety prior to the heart attack that influenced
their survival odds, the study authors note.
Researchers also looked at depression and anxiety combined, making
it impossible to identify any differences in how each of these
conditions might independently impact survival after a heart attack.
It's also unclear whether treating depression or anxiety could
impact outcomes, said Dr. Robert Carney of Washington University
School of Medicine and Barnes-Jewish Hospital in St. Louis,
Missouri, who wrote an accompanying editorial.
"We do not know for certain whether treating depression or anxiety
improves survival, but there is some evidence that it probably
does," Carney said by email. "At the very least, being free of
depression and anxiety improves quality of life."
SOURCE: https://bit.ly/2XJOo6Y and https://bit.ly/2IcxqJg European
Journal of Preventive Cardiology, online June 3, 2019.
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