Factors associated with emotional distress in patients with myocardial infarction: Results from the SWEDEHEART registry

Abstract

BackgroundEmotional distress, symptoms of depression and anxiety, is common among patients after a myocardial infarction (MI), and is associated with an increased risk of cardiovascular morbidity. Real world population data on factors associated with emotional distress in MI patients are scarce. The aim was to determine factors associated with incident emotional distress two and 12 months post MI respectively, and with persistent emotional distress, versus remittent, in patients <75 years old.DesignThis was a registry-based observational study.MethodsData from the national SWEDEHEART registry on 27,267 consecutive patients with a first-time MI, followed up at two and 12 months post MI (n = 22,911), were included in the analyses. Emotional distress was assessed with the EuroQol-5D questionnaire. Several candidate sociodemographic and clinical factors were analysed for their association with emotional distress in multivariate models.ResultsSymptoms of emotional distress were prevalent in 38% and 33% at two and 12 months post MI respectively. At both time-points, previous depression and/or anxiety, readmission for new cardiovascular event, female gender, younger age, born outside the neighbouring Nordic countries, smoking and being neither employed nor retired showed the strongest associations with emotional distress. Other factors related to medical history, the MI and its care or were only modestly associated with emotional distress. Persistent emotional distress was associated with younger age, female gender, smoking and being born outside of the Nordic countries.ConclusionPrevious depression/anxiety, female gender, younger age, smoking, born outside of the Nordic countries, neither employed nor retired and readmission due to cardiovascular events were strongly associated with emotional distress post MI. These factors may be of relevance in tailoring rehabilitation programmes.

Editor’s presentation

“…Studies suggest that patient-reported outcomes, such as quality of life and anxiety/depression scores, provide important prognostic information independently of traditional clinical findings and can predict future quality of life, morbidity and mortality in cardiac patients. 11,12 This finding may be explained by both physiological and behavioural processes. 13 A study from Denmark is here demonstrating that patients reporting symptoms of anxiety, depression, poor quality of life and severe symptom distress had a two-fold greater mortality risk, even after adjustment for common cardiovascular risk factors.…”

Collaborative care for the wearable cardioverter defibrillator patient: Getting the patient and medical team “vested and active”

“…Recent large prospective studies have indicated that as many as 38% of patients following their first-time MI experience significant emotional distress within the first 2 months. 11 In this context, the potential WCD patient is approached to consider accepting the WCD and represents a potential psychological dilemma. Does the presence of the WCD provide the patient with a sense of security or does it provide the patient with a reminder of their potential mortality?…”

Comparing 10-Item and 60-Item Big Five Personality Inventories in Explaining the Depressive Symptoms in Patients with Acute Myocardial Infarction

“…As one of the most likely consequences of MI, depression is observed in 13% -87% of the patients (6,7). However, recent studies have shown depression is not just induced by acute heart events, but factors such as female gender, younger age, marital status, smoking, hospital stay, fat intake, functional limitation, social support, negative disease beliefs, history of anxiety and depression, and personality traits including type D and neuroticism are involved in it (8)(9)(10).…”