Public Release: 

Depression doubles risk of death after heart attack, angina

Effect persists for years, underscoring the need for mental health screening and treatment

American College of Cardiology

Depression is the strongest predictor of death in the first decade following a diagnosis of coronary heart disease, according to a study scheduled for presentation at the American College of Cardiology's 66th Annual Scientific Session. The study found people with coronary heart disease who are diagnosed with depression are about twice as likely to die compared with those who are not diagnosed with depression.

"This study shows that it doesn't matter if depression emerges in the short term or a few years down the road--it's a risk factor that continually needs to be assessed," said Heidi May, PhD, a cardiovascular epidemiologist at the Intermountain Medical Center Heart Institute in Salt Lake City and the study's lead author. "I think the take-home message is that patients with coronary disease need to be continuously screened for depression, and if found to be depressed, they need to receive adequate treatment and continued follow-up."

The study focused on patients diagnosed with a heart attack, stable angina or unstable angina, all of which are caused by a reduced flow of oxygen-rich blood to the heart, typically as a result of plaque buildup in the heart's arteries. These conditions fall under the umbrella term coronary heart disease, which is the most common form of heart disease and kills about 370,000 people in the United States annually.

Researchers have long understood heart disease and depression to have a two-way relationship, with depression increasing the likelihood of heart disease and vice versa. Whereas previous studies have investigated depression occurring within a few months of a coronary heart disease diagnosis, the new study is the first to shed light on the effects of depression over the long term.

The researchers analyzed health records from almost 25,000 Intermountain Health System patients tracked for an average of nearly 10 years following a diagnosis of coronary heart disease. About 15 percent of patients received a follow-up diagnosis of depression, a substantially larger proportion than the estimated rate of 7.5 to 10 percent in the general population.

Out of 3,646 people with a follow-up diagnosis of depression, half died during the study period, compared to 38 percent of the 20,491 people who did not have a depression diagnosis. This means people with depression were twice as likely to die compared to those without depression.

After adjusting for age, gender, risk factors, other diseases, heart attack or chest pain, medications and follow-up complications, the results showed depression was the strongest predictor of death in this patient group. These results were consistent regardless of age, gender, the timing of depression onset, past history of depression or whether or not the patient had a heart attack.

Given the significant impact of depression on long-term survival, the researchers said clinicians should seek ways to better identify depression in patients with coronary heart disease, either by using patient questionnaires designed to screen for depression or by actively watching for signs of depression during follow-up examinations.

"It can be devastating to be diagnosed with coronary artery disease," May said. "Clinicians need to pay attention to the things their patients are expressing, in terms of both physical symptoms as well as emotional and nonverbal factors."

Signs of depression include persistent feelings of sadness, hopelessness or worthlessness; anxiety, irritability or restlessness; losing interest in hobbies and activities; fatigue or moving slowly; difficulty sleeping or concentrating; aches or pains without a clear physical cause; changes in appetite or weight; and thoughts of death or suicide. Depression is linked with behaviors that can be detrimental to cardiovascular health, such as reduced physical activity, poor diet, increased smoking or alcohol use and reduced compliance with medical treatment.

The study did not evaluate the impact of depression treatment on the risk of death.

May will present the study, "The Association of Depression at Any Time to the Risk of Death Following Coronary Artery Disease Diagnosis: The Intermountain INSPIRE Registry," on Friday, March 17, 2017, at 9:30 a.m. ET at Poster Hall C at the American College of Cardiology's 66th Annual Scientific Session in Washington. The meeting runs March 17-19.

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The ACC's Annual Scientific Session, which in 2017 will be March 17-19 in Washington, brings together cardiologists and cardiovascular specialists from around the world to share the newest discoveries in treatment and prevention. Follow @ACCCardioEd, @ACCMediaCenter and #ACC17 for the latest news from the meeting.

The American College of Cardiology is a 52,000-member medical society that is the professional home for the entire cardiovascular care team. The mission of the College is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy, standards and guidelines. The College operates national registries to measure and improve care, offers cardiovascular accreditation to hospitals and institutions, provides professional medical education, disseminates cardiovascular research and bestows credentials upon cardiovascular specialists who meet stringent qualifications.

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