Persistent emotional distress after a first-time myocardial infarction and its association to late cardiovascular and non-cardiovascular mortality

Abstract

Background Patients with symptoms of depression and/or anxiety – emotional distress – after a myocardial infarction (MI) have been shown to have worse prognosis and increased healthcare costs. However, whether specific subgroups of patients with emotional distress are more vulnerable is less well established. The purpose of this study was to identify the association between different patterns of emotional distress over time with late cardiovascular and non-cardiovascular mortality among first-MI patients aged <75 years in Sweden. Methods We utilized data on 57,602 consecutive patients with a first-time MI from the national SWEDEHEART registers. Emotional distress was assessed using the anxiety/depression dimension of the European Quality of Life Five Dimensions questionnaire two and 12 months after the MI, combined into persistent (emotional distress at both time-points), remittent (emotional distress at the first follow-up only), new (emotional distress at the second-follow up only) or no distress. Data on cardiovascular and non-cardiovascular mortality were obtained until the study end-time. We used multiple imputation to create complete datasets and adjusted Cox proportional hazards models to estimate hazard ratios. Results Patients with persistent emotional distress were more likely to die from cardiovascular (hazard ratio: 1.46, 95% confidence interval: 1.16, 1.84) and non-cardiovascular causes (hazard ratio: 1.54, 95% confidence interval: 1.30, 1.82) than those with no distress. Those with remittent emotional distress were not statistically significantly more likely to die from any cause than those without emotional distress. Discussion Among patients who survive 12 months, persistent, but not remittent, emotional distress was associated with increased cardiovascular and non-cardiovascular mortality. This indicates a need to identify subgroups of individuals with emotional distress who may benefit from further assessment and specific treatment.

The course of emotional distress and late mortality following myocardial infarction: Implications for depression screening and treatment

“…As the authors note, the finding that persistent depression and/or anxiety is associated with a higher risk of mortality is consistent with the results of many (although not all) of the previous studies with mortality and medical morbidity as endpoints, as cited by Lissa˚´ker et al 7 Most of those studies used standardized depression or anxiety questionnaires or diagnostic interviews, and assessed depression or anxiety at various times during follow-up. The present study adds to our knowledge by showing that patients who report distress at 2 months and survive to the 12-month follow-up continue to be at higher risk of mortality only if they continue to report distress after 12 months following the acute event.…”

“…In this issue of the journal, Lissǻker and colleagues 7 address this question using data from the national SWEDEHEART registry of patients under the age of 75 years with a first MI. 7 The authors used a single item from the European Quality of life five dimensions (EQ-5D) questionnaire to assess ‘distress’. This item asks patients to report whether they feel depressed or anxious ‘to some extent’, ‘extremely’, or not at all.…”

The Effect of Aromatherapy and the Benson Relaxation Technique on the Anxiety of Patients With Acute Coronary Syndrome: Randomized Controlled Trial

“…Complex care and advanced equipment, threatening disorder, presence of unfamiliar people and devices, lack of space and time perception, permanent monitoring of vital signs and cardiac activity, and unknown odors are among the stressors in the Cardiac Care Unit (CCU) (Heidemann et al 2011). Post-ACS anxiety has various consequences and is related to the high probability of cardiovascular and non-cardiovascular mortality and can affect the recovery process after ACS, hospital stay duration, and complications (Lissåker et al 2019;Li et al 2019). Anxiety can be relieved using antidepressants, benzodiazepines, psychotherapy (Celano et al 2016), non-pharmacological measures, and complementary medicine (Ravindran & da Silva 2013).…”

The effects of mental health on myocardial infarction

“…We read with interest the article by Lissa˚ker et al 1 on persistent emotional distress after myocardial infarction (MI) and its effects on mortality. This study looked at patterns of emotional distress post MI and its effects on late cardiovascular mortality.…”