A new scientific statement from the American Heart Association published in Circulation reports that psychological distress following a heart attack affects an estimated 33-50% of survivors and significantly increases their risk of future cardiac events. The statement emphasizes that persistent psychological symptoms lasting up to 12 months after a heart attack make survivors nearly 1.5 times more likely to experience another cardiac event. Depression develops in approximately one in three heart attack survivors annually, compared to less than one in ten adults in the general U.S. population. Anxiety and stress affect up to 50% of heart attack survivors during hospitalization, persisting in 20-30% of people for several months or longer after discharge.
Those at higher risk include people living alone, women, unmarried individuals, unemployed persons, immigrants to the U.S., those lacking social support, and people with a history of mental health conditions or chronic illness. The biological connection between psychological distress and heart health involves multiple mechanisms. Damage to heart muscle from a heart attack triggers inflammation that can cause hormonal shifts and brain chemistry changes contributing to depression, anxiety, or PTSD symptoms. Acute psychological stress can cause coronary vasoconstriction, reduced blood flow to the heart, and irregular heart rhythms. Chronic stress triggers the body's fight-or-flight response, raising blood pressure and inflammation in blood vessels.
Evidence-based treatments for post-heart attack psychological distress include cognitive behavioral therapy, medications such as selective serotonin reuptake inhibitors (SSRIs), mindfulness-based stress reduction strategies, and healthy lifestyle changes. Cardiac rehabilitation programs, which include mental health screening, stress management education, and therapy referrals, have been shown to reduce symptoms of depression, anxiety, and stress while improving cardiac outcomes. However, less than 20% of eligible patients participate in these programs due to barriers including transportation challenges, scheduling issues, and lack of available programs in under-resourced communities.
The statement calls for more research to confirm whether treating psychological distress can improve cardiovascular outcomes, noting that while therapy, medication, lifestyle changes, and cardiac rehabilitation programs improve psychological health and quality of life, their impact on long-term cardiovascular risk requires further investigation. Health care professionals are encouraged to be alert to signs of psychological distress in patients after a heart attack and consider gentle referrals to mental health professionals when appropriate.
