Chronic depression after heart attack due to increased risk of death

(Reuters Health) – A recent study suggests that survivors of heart attacks with chronic mood disorders are more likely to die prematurely than their counterparts who do not suffer from these problems.

Researchers have noted in the European Journal of Preventive Cardiology that patients with anxiety or depression have already had longer hospital stays and a poorer prognosis after a heart attack. However, previous research did not clearly indicate to physicians whether patients with specific types of emotional distress may place them at greater risk of serious complications or premature death.

For the present study, researchers evaluated nearly 58,000 patients in emotional distress two months after a heart attack and 12 months after the event. Overall, 21% of patients reported persistent psychological problems in both badessments.

The researchers followed a majority of patients for at least 4 years. Compared to those who reported no emotional distress, people who felt depressed or anxious at both badessments were 46% more likely to die from cardiovascular causes during the follow-up period and 54% more likely to die from cardiovascular disease. other causes.

"Temporary mood swings, if they are not too frequent or dramatic, are part of everyday life," said Erik Olsson, lead author of the study, the University of Uppsala in Sweden.

"Feeling a little depressed after a heart attack could even be a good thing if it forces you to withdraw a little and rest a bit," added Olsson. "Emotional states help us regulate our behaviors."

About 15% of the patients in the study experienced symptoms of emotional distress two months after the heart attack, which they did not report after one year. Their chances of dying during the study period were not different from those of those who did not suffer from anxiety or depression at one or the other. Evaluation.

It is possible that people who reported depression and anxiety in both badessments struggled to follow doctors' orders for an ideal recovery, Olsson said via e-mail.

"Chronic emotional distress makes it more difficult to adopt lifestyle changes that improve the prognosis after a heart attack," Olsson said. "These include quitting, doing physical activity, eating healthy, reducing stress and taking prescription medications."

About 11% of patients initially had no symptoms of emotional distress, but experienced some degree of depression or anxiety after one year.

These individuals did not appear to be at increased risk of dying from cardiovascular causes during the study period compared to patients reporting no emotional distress, but 46% more likely to die from other causes. .

These people may have had distress that was not directly related to their heart attack, Olsson said. Instead, they may have suffered depression or anxiety because of other risk factors for mood disorders such as poverty, limited education or the lack of spouse or job.

The study was not a controlled experiment designed to prove whether or how mood disorders could directly hasten death after a heart attack.

It is also possible that some people participating in the study were suffering from depression or undiagnosed anxiety before the heart attack that influenced their chances of survival, note the study authors.

The researchers also examined depression and anxiety combined, making it impossible to identify differences in how each of these conditions could have an independent impact on survival after a heart attack.

It's also unclear whether treatment for depression or anxiety could impact outcomes, said Dr. Robert Carney of the University of Washington's Faculty of Medicine and Barnes-Jewish Hospital of St. Louis, Missouri, who wrote an accompanying editorial.

"We do not know for sure whether treatment for depression or anxiety improves survival, but there is some evidence to support it," Carney said via e-mail. "At the very least, the absence of depression and anxiety improves the quality of life."

SOURCE: https://bit.ly/2XJOo6Y and https://bit.ly/2IcxqJg European Journal of Preventive Cardiology, online 3 June 2019.