Treating the psychological part of a heart attack can keep patients healthier

A heart patient’s mental state has a lot to do with their recovery. A recent study found that treating anxiety and depression in cardiac patients dramatically lowered the chance they would return to a hospital to be readmitted, evaluated in an emergency department or die.

The study, published March 24, 2024 in the Journal of the American Heart Association, looked at data from 1,563 people in Ohio who had been hospitalized for heart failure or heart attack or inadequate blood flow to the heart’s coronary arteries, and who had anxiety or depression. The study followed them for four years afterward. Of the total group, 23 percent were given psychotherapy and antidepressants, 29 percent were given just antidepressants, 15 percent were given only psychotherapy and 33 percent were given no mental health treatment.

The results:

• Patients who got both psychotherapy and antidepressants were 75 percent less likely to die from any cause.
• The risk of hospital readmission dropped by 75 percent for patients who received both therapies, 58 percent for just antidepressants and 49 percent for psychotherapy alone.
• The chance of a subsequent evaluation in an emergency department decreased 74 percent for patients who got both treatments, 53 percent for just psychotherapy and 49 percent for antidepressants alone.

Cape Cod Healthcare cardiologist Elissa Thompson, MD, said the study quantified what she and colleagues deal with in their work, and underscores the need to treat the whole patient, not just the heart.

Experiencing a heart attack is a traumatic event in a person’s life, and there are repercussions, she said.

“Depression and anxiety are so prevalent,” she said. “It’s something we see all the time.”

Dr. Thompson, who is medical director of Cape Cod Hospital’s Cardiac Rehabilitation program, said patients who go through the program meet with a licensed social worker who can refer them for psychotherapy and antidepressant treatment. Cardiac patients tend to be older, she said, and may be somewhat reticent about discussing their mental health. Having them meet with a social worker can help them open up.

“It normalizes the discussion,” she said.

Mended Hearts of Cape Cod, a local group supported by Cape Cod Healthcare, gives patients who have undergone cardiac surgery an opportunity to meet with fellow patients for sharing and support.

Depression and Anxiety as Risk Factors

Recovery requires exercise, a balanced diet and a positive outlook. People who are depressed tend to be less active, may not eat enough food or healthy food, and their sense of well-being is low. They may feel physically sicker than they actually are, Dr. Thompson said.

“We know how negatively it will affect their recovery” if untreated, she added.

More needs to be done to better screen patients for depression and anxiety, Dr. Thompson said. While cardiologists learn about mental health’s effects on patients in their medical training, they aren’t psychotherapists.

“I know when I have someone in the hospital, I’ll have some labs done … I have a goal,” she said. “I don’t have that from a mental perspective.”

Limited time, resources and staffing all hamper the ability to better deal with the problem, which, unfortunately, means some patients don’t get the treatment they need, Dr. Thompson said.

“Their health is worsening because many health systems are not addressing it. Their mental health is not being seen as part of the entire parcel,” she said.

Study’s Importance

The Ohio study may help change the situation, Dr. Thompson said, by demonstrating the significant benefits of treating anxiety and depression in heart patients.

“I think it’s really helpful to open up new lines of research, new ways of thinking,” she said. “Thinking about mental health as a modifiable risk factor, as well.”

The authors of the Ohio study noted earlier research showed depression contributes to illness and death in heart failure patients, has a “major impact” on coronary artery disease and a similar relationship with cardiovascular disease. Less research has been done on anxiety, but studies have reported ties to incidence and death in coronary heart disease and heightened chance of heart failure, they wrote. The authors concluded that while much work has been done on the effects of mental health on cardiovascular disease, not much has been done on outcomes.

“To the authors' knowledge, this article is the first to show that mental health treatment may be associated with reduced risk for relevant outcomes,” they wrote.

“The study shows clearly that there’s something to it,” Dr. Thompson said.