Depression increases risk of complications after heart attack

By Kurt Ullman, Contributing Writer
Health Behavior News Service

People who suffer from severe depression following a heart attack might be more likely to experience cardiac complications while hospitalized, according to a new study.

"There is good evidence that if a person has depression after a heart attack, they are more likely to die from cardiac causes in the following months and years," said lead author Jeff Huffman, M.D., assistant professor of psychiatry at Harvard Medical School. "No one had yet studied whether depression impacts cardiac outcomes immediately after a heart attack-the time we see the most complications."

The study included 129 patients at Massachusetts General Hospital. Within 72 hours of having a heart attack, each participant underwent an interview to determine if he or she suffered from depression or anxiety. Seventeen of the original group members had a diagnosis of major depression lasting for at least two weeks.

The presence of major depression was a significant predictor of heart rhythm problems, congestive heart failure or a second heart attack.

Anxiety did not affect the risk for any in-hospital complication.

"The results suggest that physicians should be especially mindful of treating depression in patients with cardiac risk factors," Huffman said. "They also suggest close in-hospital monitoring of heart attack patients with major depression given this increased risk for complications."

Huffman noted that the study, which appears in the July-August issue of the journal Psychosomatics, is a small, preliminary study. Most of the participants were white males, so its findings might not apply to other groups.

"What is surprising is that differences in outcomes were seen in a relatively short time. The new observation is that risk for these bad outcomes start while patients are still in the hospital," said David Bush, M.D., associate professor at The Johns Hopkins University School of Medicine and Heart Institute.

"The separation between heart disease, typically managed by cardiologists and internists, and mental disease, typically managed by psychiatrists, is not as great as many seem to think." Bush said. "Physicians and patients should be sensitive to this and work on treating depression in addition to controlling diabetes, lowering blood pressure and lowering cholesterol."

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Huffman JC, Smith FA, Blais MA, et al. Pre-Existing Major Depression Predicts In-Hospital Cardiac Complications After Acute Myocardial Infarction. Psychosomatics 2008 Jul;49:309-316   [Abstract]