Patients with depression are nearly 6 times more likely to die within 6 months after a heart attack than those without depression. The increased risk of death in patients with depression persists up to 18 months after the heart attack. But despite the fact that post-heart-attack depression is common and burdensome, the condition remains under-recognized and under-treated, scientists say.
Women are more likely to develop anxiety and depression after a heart attack (myocardial infarction; MI) than men, according to research presented at Acute Cardiovascular Care 2014 by Professor Pranas Serpytis from Lithuania.
Acute Cardiovascular Care is the annual meeting of the Acute Cardiovascular Care Association (ACCA) of the European Society of Cardiology (ESC) and takes place 18-20 October in Geneva, Switzerland.
Professor Serpytis said: “The World Health Organization predicts that by 2020 depression will be the second leading cause of disability and mortality in the world, surpassed only by ischaemic heart disease. Major depression follows MI in approximately 18% of cases and is an important predictor of disability and poor quality of life in the year post-MI.”
He continued: “Patients with depression are nearly 6 times more likely to die within 6 months after an MI than those without depression. The increased risk of death in patients with depression persists up to 18 months after the MI. But despite the fact that post-MI depression is common and burdensome, the condition remains under-recognised and undertreated.”
The current study investigated the impact of gender and cardiovascular disease risk factors on the risk of developing depression and anxiety after an MI.
The study included 160 patients admitted with a myocardial infarction to the Vilnius University Hospital Santariskiu Clinics in Vilnius, Lithuania. Patients were interviewed at least 1 month after the MI to collect information on demographic (including sex, age, education, marital status) and clinical characteristics (incidence of diabetes mellitus, previous treatment for hypertension, previous MI), other cardiovascular disease risk factors (smoking, physical activity), and history of mental health issues.
Depression and anxiety were both assessed using the Hospital Anxiety and Depression Scale (HADS): no depression and anxiety (0-7 score), possible depression and anxiety (8-10 score), mild to moderate levels of depression and anxiety symptoms (11+ score).
The researchers found that nearly one quarter of patients in the study were depressed (24.4%) and of those, 28.2% had received treatment with antidepressants (p<0.05). The average HADS score for depression was 6.87 (±4.6) in men and 8.66 (± 3.7) in women (p<0.05). For anxiety the mean score was 7.18 (±4.6) in men and 8.20 (±3.9) in women (p<0.05).
Professor Serpytis said: “We found that women were more likely to develop anxiety and depression after a heart attack than men. More research is needed to discover the possible reasons for this.”
The researchers also found an association between anxiety and smoking. In the study, 15.6% patients were current smokers and their mean HADS score for anxiety was 10.16 (±4.9). An additional 77.5% of patients had never smoked and their mean HADS score for anxiety was 7.3 (±4.1), while the 6.9% patients who had quit smoking more than 2 years ago had a mean HADS score for anxiety of 4.55 (±3.7) (p<0.05).
Professor Serpytis said: “Current smokers were more likely to have anxiety after an MI than never smokers or people who had quit smoking more than two years ago. We did not find any association between smoking and depression after an MI.”
Physically inactive patients tended to be depressed, with a mean HADS score of 8.96 (+4.1). Overall, 64% of patients with depression said they were not physically active (p<0.05).
Professor Serpytis said: “Women are misrepresented in many clinical studies on MI even though they often have worse outcomes. Our study shows that women are more likely to develop anxiety and depression after MI than men but until now this issue has been largely unnoticed. Clinicians should assess MI patients, particularly women, for anxiety and depression so that timely treatment can be started.”
He concluded: “Our study suggests that encouraging patients to quit smoking and increase their physical activity levels should reduce their risks of anxiety and depression after MI. More research is needed on the links between myocardial infarction and mental health problems.”
