Many Cardiac Patients Depressed, But May Not Get Medications For It

A new study has found that many heart attack patients are depressed, but are less often prescribed antidepressants than people who have not had a heart attack.

“Stress-related disorders, such as depression and exhaustion, are increasingly common and have been the main reason for long-term sick leave in Sweden for more than a decade,” said Dr. Barbro Kjellström, a researcher at the Karolinska Institute in Stockholm, Sweden.

“We know that stress and depression are big risk factors for heart attack and we confirmed this connection in our study. But what was new and astonishing was that heart attack patients less often receive treatment for depression.”

The research, presented at EuroHeartCare 2016, was a sub-study of the PAROKRANK study, which found that periodontitis increased the risk of having a first myocardial infarction by 30 percent.

The study included 805 patients under 75 years of age who had experienced a first myocardial infarction and 805 people without a myocardial infarction matched for age, gender and where they lived. Average age was 62 and 81 percent of the study participants were men, the researchers noted.

The researchers collected detailed information on stress, depression and exhaustion, using what they called “well-established, validated questionnaires.”

Study participants were asked to grade the level of stress they felt at home and at work and about their economic situation. They also were asked about stressful events during the past year and their feeling of control in life, both at work and at home.

The researchers found that 14 percent of the heart attack patients had symptoms of depression compared to just 7 percent of the control group. They also found that symptoms of depression or exhaustion were associated with a doubled risk of heart attack.

When the researchers looked at types of stress, they found that more patients had experienced stress at home (18 percent compared to 11 percent of the control group) and at work (42 percent versus 32 percent). Even moderate levels of stress at home were associated with a doubled heart attack risk, they found.

“Patients who had a heart attack had more stress both at work and at home, but interestingly there was no difference between the two groups as regards to financial stress,” Kjellström said. “Patients also reported that they had less control of their work situation. In addition, those who had a heart attack were more likely to be divorced whereas people in the control group more often lived with a partner.”

“When asked ‘Were you angry during the last 24 hours?’ many more patients said yes compared to controls,” she added. “It appears that stress in life can also trigger feelings of anger in patients who have had a heart attack.”

The study also found that just 16 percent of heart attack patients with depression received antidepressants compared to 42 percent of the control group with depression.

“Our results suggest that heart attack patients are undertreated with antidepressants,” Kjellström said. “When we looked at the participants in the study who had experienced depression, we saw that more than twice as many controls as patients were prescribed antidepressant medication. We did not ask about cognitive therapies, but it’s unlikely that the large gap in treatment was filled in this way.”

“It appears that patients who had a heart attack did not seek help for their depression, or if they did, their symptoms were not accurately recognized and managed,” she continued. “An important take-home message is for clinicians to ask patients ‘How do you feel?’ and listen to the reply, rather than zoning out because they are stressed themselves.”


Source: European Society of Cardiology