Anxiety and Depression May Increase Adverse Event Risk After First MI

Risk for mortality and CV adverse events is increased in patients with anxiety and depression recovering from first-time MI.

Anxiety and depression increase risk for mortality and recurrent cardiovascular events among patients with first-episode myocardial infarction (MI), according to results of a study published in the International Journal of Cardiology.

Up to 40% of patients with MI report symptoms of anxiety or depression. This study was designed to assess how the presence of anxiety or depression may affect recurrence or mortality following MI.

Data for this study were sourced from 4 national registries in Sweden. Among 192,059 MI events that occurred between 2006 and 2015, a total of 45,096 met the criteria for first-time MI and had sufficient data about anxiety and depression diagnoses or symptoms and follow-up.

Among the study population, 3427 patients had a previous diagnosis of anxiety or depression, 14,879 had self-reported symptoms of anxiety or depression, and 26,785 had neither. The cohorts were mean ages of 59.03 to 62.59 years, 62.1% to 79.4% were men, 27.6% to 44.9% were current smokers, and 39.4% to 40.8% had hypertension.

. . . patients with a psychiatric history have an elevated post-MI risk despite not reporting symptoms at the time of MI.

During a median follow-up of 960 days, 4.6% of patients died, 29.2% had an MI recurrence, 13.7% were hospitalized with heart failure, 3.1% had a stroke, and 1.4% had new-onset atrial fibrillation.

Patients with a history of diagnosed anxiety or depression had a 1-year mortality rate of 1.7%, a 5-year mortality rate of 5.8%, a 1-year MI recurrence rate of 30.2%, and a 5-year MI recurrence rate of 33.8%. The patients with self-reported symptoms of anxiety or depression had a 1-year mortality rate of 1.2%, a 5-year mortality rate of 5.4%, a 1-year MI recurrence rate of 26.2%, and a 5-year MI recurrence rate of 29.8%. The patients without anxiety or depression had a 1-year mortality rate of 0.8%, a 5-year mortality rate of 4.0%, a 1-year MI recurrence rate of 25.2%, and a 5-year MI recurrence rate of 28.3%.

The patients with a history of diagnosed anxiety or depression were at increased risk for all-cause mortality (adjusted hazard ratio [aHR], 1.86; 95% CI, 1.36-2.53), MI recurrence (aHR, 1.14; 95% CI, 1.06-1.22), the composite event of mortality and MI recurrence (aHR, 1.15; 95% CI, 1.07-1.23), and the composite event of mortality and all cardiovascular outcomes (aHR, 1.19; 95% CI, 1.12-1.26) at 1 year.

This study may have been limited as diagnoses of anxiety or depression made by primary care providers were not included.

These data indicate that a history of anxiety or depression or self-reported symptoms increases risk for mortality and cardiovascular outcomes at 1 year. “A detailed assessment of both psychiatric history and self-reported symptoms seems warranted during CR [cardiac rehabilitation], in part because patients with a psychiatric history have an elevated post-MI risk despite not reporting symptoms at the time of MI,” wrote the study authors.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on The Cardiology Advisor

References:

Flygare O, Boberg J, Rück C, et al. Association of anxiety or depression with risk of recurrent cardiovascular events and death after myocardial infarction: a nationwide registry study. Int J Cardiol. Published online April 18, 2023. doi:10.1016/j.ijcard.2023.04.023