An observational study of the occurrence of anxiety, depression and self-reported quality of life 2 years after myocardial infarction

Main Article Content

Catrin Henriksson
Mona-Lisa Wernroth
Christina Christersson*

Abstract

Background: Patients with myocardial infarction (MI) often experience anxiety, depression and poor quality of life (QoL) compared with a normative population. Mood disturbances and QoL have been extensively investigated, but only a few studies have examined the long-term effects of MI on these complex phenomena.


Aims: To examine the levels and associated predictors of anxiety, depression, and QoL in patients 2 years after MI.


Methods: This was a single center, observational study of patients with MI (n=377, 22% women, median age 66 years). Two years after MI (2012-2014), the patients were asked to answer the Hospital Anxiety and Depression Scale (HADS) and EuroQol 5-dimension (EQ-5D-3L) questionnaires.


Results: Most patients experienced neither anxiety (87%, 95% confidence interval [CI]: 83-90%) nor depression (94%, 95% CI: 92-97%) 2 years post-MI. Elderly patients experienced more depression than younger patients (p=0.003) and women had higher anxiety levels than men (p=0.009).


Most patients had “no problems” with any of the EQ-5D-3L dimensions (72-98%), but 48% (95% CI: 43%-53%) self-reported at least “some problems” with pain/discomfort. In a multiple logistic regression model (EQ-5D-3L) higher age (p<0.001) and female sex (p<0.001) were associated with more pain/discomfort. Female sex (p=0.047) and prior MI (p=0.038) were associated with anxiety/depression. History of heart failure was associated with worse mobility (p=0.005) and problems with usual activities (p=0.006). The median total health status of the patients (EQ-VAS) was 78 (95% CI: 75-80)

Article Details

Henriksson, C., Wernroth, M.-L., & Christersson, C. (2018). An observational study of the occurrence of anxiety, depression and self-reported quality of life 2 years after myocardial infarction. Journal of Cardiology and Cardiovascular Medicine, 3(3), 052–063. https://doi.org/10.29328/journal.jccm.1001027
Research Articles

Copyright (c) 2018 Henriksson C, et al.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

The Journal of Cardiology and Cardiovascular Medicine is committed in making it easier for people to share and build upon the work of others while maintaining consistency with the rules of copyright. In order to use the Open Access paradigm to the maximum extent in true terms as free of charge online access along with usage right, we grant usage rights through the use of specific Creative Commons license.

License: Copyright © 2017 - 2025 | Creative Commons License Open Access by Journal of Cardiology and Cardiovascular Medicine is licensed under a Creative Commons Attribution 4.0 International License. Based on a work at Heighten Science Publications Inc.

With this license, the authors are allowed that after publishing with the journal, they can share their research by posting a free draft copy of their article to any repository or website.

Compliance 'CC BY' license helps in:

Permission to read and download
Permission to display in a repository
Permission to translate
Commercial uses of manuscript

'CC' stands for Creative Commons license. 'BY' symbolizes that users have provided attribution to the creator that the published manuscripts can be used or shared. This license allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.

Please take in notification that Creative Commons user licenses are non-revocable. We recommend authors to check if their funding body requires a specific license. 

Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380: 2197-2223. Ref.: https://goo.gl/bnu2pf

Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, et al. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J. 2016; 37: 3232-3245. Ref.: https://goo.gl/od7AUP

Kubzansky LD, Kawachi I. Going to the heart of the matter: do negative emotions cause coronary heart disease? J Psychosom Res. 2000; 48: 323-337. Ref.: https://goo.gl/gg64vi

Lett HS, Blumenthal JA, Babyak MA, Sherwood A, Strauman T, et al. Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosom Med. 2004; 66: 305-315. Ref.: https://goo.gl/EyfNV5

Roest AM, Zuidersma M, de Jonge P. Myocardial infarction and generalised anxiety disorder: 10-year follow-up. Br J Psychiatry. 2012; 200: 324-329. Ref.: https://goo.gl/SrFvCK

Hare DL, Toukhsati SR, Johansson P, Jaarsma T. Depression and cardiovascular disease: a clinical review. Eur Heart J. 2014; 35: 1365-1372. Ref.: https://goo.gl/9KzBpZ

Lichtman JH, Froelicher ES, Blumenthal JA, Carney RM, Doering LV, et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association. Circulation. 2014; 129: 1350-1369. Ref.: https://goo.gl/VHNSgv

Watkins LL, Koch GG, Sherwood A, Blumenthal JA, Davidson JR, et al. Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease. J Am Heart Assoc. 2013; 2: e000068. Ref.: https://goo.gl/jVtsXg

Moser DK, Dracup K, McKinley S, Yamasaki K, Kim CJ, et al. An international perspective on gender differences in anxiety early after acute myocardial infarction. Psychosom Med. 2003; 65: 511-516. Ref.: https://goo.gl/qauiKu

Moser DK, Riegel B, McKinley S, Doering LV, An K, et al. Impact of anxiety and perceived control on in-hospital complications after acute myocardial infarction. Psychosom Med. 2007; 69: 10-16. Ref.: https://goo.gl/Qub3TH

Strik JJ, Denollet J, Lousberg R, Honig A. Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction. J Am Coll Cardiol. 2003; 42: 1801-1807. Ref.: https://goo.gl/PDgyRX

von Kanel R. Platelet hyperactivity in clinical depression and the beneficial effect of antidepressant drug treatment: how strong is the evidence? Acta Psychiatr Scand. 2004; 110: 163-177. Ref.: https://goo.gl/44cFce

Sherwood A, Hinderliter AL, Watkins LL, Waugh RA, Blumenthal JA. Impaired endothelial function in coronary heart disease patients with depressive symptomatology. J Am Coll Cardiol. 2005; 46: 656-659. Ref.: https://goo.gl/2jcL24

Miller NH. Adherence behavior in the prevention and treatment of cardiovascular disease. J Cardiopulm Rehabil Prev. 2012; 32: 63-70. Ref.: https://goo.gl/cKAyFo

Simpson E, Pilote L. Quality of life after acute myocardial infarction: a systematic review. Can J Cardiol. 2003; 19: 507-511. Ref.: https://goo.gl/R22HAL

Mollon L, Bhattacharjee S. Health related quality of life among myocardial infarction survivors in the United States: a propensity score matched analysis. Health Qual Life Outcomes. 2017; 15: 235. Ref.: https://goo.gl/MgDJvQ

Kang K, Gholizadeh L, Inglis SC, Han HR Correlates of health-related quality of life in patients with myocardial infarction: A literature review. Int J Nurs Stud. 2017; 73: 1-16. Ref.: https://goo.gl/dZiYWB

Perers E, From Attebring M, Caidahl K, Herlitz J, Karlsson T, et al. Low risk is associated with poorer quality of life than high risk following acute coronary syndrome. Coron Artery Dis. 2006; 17: 501-510. Ref.: https://goo.gl/BT1fcX

de Jonge P, Spijkerman TA, van den Brink RH, Ormel J. Depression after myocardial infarction is a risk factor for declining health related quality of life and increased disability and cardiac complaints at 12 months. Heart. 2006; 92: 32-39. Ref.: https://goo.gl/c1sYra

Parashar S, Rumsfeld JS, Spertus JA, Reid KJ, Wenger NK. et al. Time course of depression and outcome of myocardial infarction. Arch Intern Med. 2006; 166: 2035-2043. Ref.: https://goo.gl/X6cX47

Norris CM, Hegadoren K, Pilote L. Depression symptoms have a greater impact on the 1-year health-related quality of life outcomes of women post-myocardial infarction compared to men. Eur J Cardiovasc Nurs. 2007; 6: 92-98. Ref.: https://goo.gl/aWuh72

van Beek MH, Mingels M, Voshaar RC, van Balkom AJ, Lappenschaar M, et al. One-year follow up of cardiac anxiety after a myocardial infarction: a latent class analysis. J Psychosom Res. 2012; 73: 362-368. Ref.: https://goo.gl/UgFQuW

Christersson C, Lindahl B, Berglund L, Siegbahn A, Oldgren J. et al. The utility of coagulation activity for prediction of risk of mortality and cardiovascular events in guideline-treated myocardial infarction patients. Ups J Med Sci. 2017; 122: 224-233. Ref.: https://goo.gl/2oULPv

Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002; 52: 69-77. Ref.: https://goo.gl/g2enya

Ellis JJ, Eagle KA, Kline-Rogers EM, Erickson SR. Validation of the EQ-5D in patients with a history of acute coronary syndrome. Curr Med Res Opin. 2005; 21: 1209-1216. Ref.: https://goo.gl/uuLHza

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67: 361-370. Ref.: https://goo.gl/x9XgCS

Bell ML, Fairclough DL, Fiero MH, Butow PN. Handling missing items in the Hospital Anxiety and Depression Scale (HADS): a simulation study. BMC Res Notes. 2016; 9: 479. Ref.: https://goo.gl/4crmX9

Szende A, Janssen B, Cabasés JM, EuroQol G. Self-reported population health: an international perspective based on EQ-5D (2014 ed.) 2014; Dordrecht: Springer. Ref.: https://goo.gl/B3sMHy

Hanssen TA, Nordrehaug JE, Eide GE, Bjelland I, Rokne B. Anxiety and depression after acute myocardial infarction: an 18-month follow-up study with repeated measures and comparison with a reference population. Eur J Cardiovasc Prev Rehabil. 2009; 16: 651-659. Ref.: https://goo.gl/ZjjoFp

Larsson IM, Wallin E, Rubertsson S, Kristofferzon ML. Health-related quality of life improves during the first six months after cardiac arrest and hypothermia treatment. Resuscitation. 2014; 85: 215-220. Ref.: https://goo.gl/7FiF6e

SWEDEHEART Annual report. 2015. 2015; Ref.: https://goo.gl/vQVrdG

Frasure-Smith N, Lespérance F, Talajic M. The impact of negative emotions on prognosis following myocardial infarction: is it more than depression? Health Psychol. 1995; 14: 388-398. Ref.: https://goo.gl/MiognK

Myers V, Gerber Y, Benyamini Y, Goldbourt U, Drory Y. Post-myocardial infarction depression: increased hospital admissions and reduced adoption of secondary prevention measures--a longitudinal study. J Psychosom Res. 2012; 72: 5-10. Ref.: https://goo.gl/apxVqu

Lampe FC, Whincup PH, Wannamethee SG, Ebrahim S, Walker M, et al. Chest pain on questionnaire and prediction of major ischaemic heart disease events in men. Eur Heart J. 1998; 19: 63-73. Ref.: https://goo.gl/ihKgk7

Spertus JA, Jones P, McDonell M, Fan V, Fihn SD. Health status predicts long-term outcome in outpatients with coronary disease. Circulation, 106. 2002; 43-49. Ref.: https://goo.gl/8RVqG5

Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Prodzinski J, et al. Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease. J Am Coll Cardiol. 1995; 25: 333-341. Ref.: https://goo.gl/JxhnB1

Lisspers J, Nygren A, Söderman E. Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample. Acta Psychiatr Scand. 1997; 96: 281-286. Ref.: https://goo.gl/to5wCG

Schweikert B, Hahmann H, Leidl R. Validation of the EuroQol questionnaire in cardiac rehabilitation. Heart. 2006; 92: 62-67. Ref.: https://goo.gl/gg4tTv