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Abstract
IntroductionPatients who are anxious or depressed after an acute cardiac event are at increased risk of a subsequent event and premature death. It is therefore important to identify these patients early in order to initiate supportive or even preventive measures. In the present study, we report on the prevalence of anxiety and depression during the first 12 months after an acute cardiac event, and the patient characteristics predictive of increased anxiety and depression risk in early and late convalescence.MethodsWe recruited a sample of 911 patients with acute myocardial infarction (AMI), acute coronary syndrome (ACS), and/or unstable angina (UA), and/or undergoing coronary artery bypass graft surgery (CABGS). Patients completed the Hospital Anxiety and Depression Scale (HADS) close to the time of their event, and again during early (2–4 months post-event) and late (6–12 months post-event) convalescence. Using HADS-A and HADS-D cut-offs of 8+, prevalence rates for anxiety, depression, and comorbid anxiety and depression were determined for each timepoint. Chi-square tests and odds ratios were used to identify baseline patient characteristics associated with increased anxiety and depression risk over 12 months.ResultsAnxiety rates were 43, 28, and 27% at the time of the event, early, and late convalescence. Depression rates were 22, 17, and 15%, respectively. Factors consistently associated with increased anxiety and depression risk were history of depression, financial strain, poor self-rated health, low socioeconomic status, younger age (<55 years), and smoking. Obesity, diabetes, and social isolation (living alone or being unpartnered) were identified as important albeit less significant risk factors. Neither sex nor event type were predictive of anxiety or depression.ConclusionThis large patient sample provided the opportunity to identify rates of anxiety and depression during the 12 months after a cardiac event and key patient characteristics for increased risk. These risk factors are easily identifiable at the time of the event, and could be used to guide the targeting of support programs for patients at risk.
Highlights
Patients who are anxious or depressed after an acute cardiac event are at increased risk of a subsequent event and premature death
Anxiety and depression are both common after an acute cardiac event, such as acute myocardial infarction (AMI) or coronary artery bypass graft surgery (CABGS)
In a 12-year follow-up study of 170 female AMI and CABGS patients, we found that the mortality rate was highest in those whose depression symptoms worsened in the 2 months after hospital discharge, and lowest in those whose inhospital symptoms remitted by 2 months (Murphy et al, 2013)
Summary
Patients who are anxious or depressed after an acute cardiac event are at increased risk of a subsequent event and premature death. While relatively few studies have reported rates of anxiety and depression at later points during patients’ convalescence, there is evidence that early symptoms resolve for many patients during the first few months after hospital discharge (Murphy et al, 2008a, 2013, 2016). Anxiety at one to 2 months post-event has been found to confer a 2.3 to 2.8-fold increased risk of adverse cardiac events (Strik et al, 2003; Frasure-Smith and Lesperance, 2008) For this reason, it is important to identify patients at risk of symptoms of anxiety or depression that emerge later or persist into convalescence, rather than identifying only those with symptoms present in hospital (Murphy et al, 2016). It is important to identify patient characteristics other than early anxious or depressive symptoms, given that these cannot be regarded as a good indicator of later mental health status (Murphy et al, 2008a, 2013, 2016)
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