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Cited by 1,208Cardiac Health and Mental HealthAcute Myocardial Infarction ResearchCardiac Imaging and Diagnostics

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

Open access
Lichtman, Judith H., Froelicher, Erika S., Blumenthal, James A., Carney, Robert M., Doering, Lynn V., Frasure-Smith, Nancy, Freedland, Kenneth E., Jaffe, Allan S. +4 more·2014·Circulation
DOI 10.1161/cir.0000000000000019
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Abstract

Background—: Although prospective studies, systematic reviews, and meta-analyses have documented an association between depression and increased morbidity and mortality in a variety of cardiac populations, depression has not yet achieved formal recognition as a risk factor for poor prognosis in patients with acute coronary syndrome by the American Heart Association and other health organizations. The purpose of this scientific statement is to review available evidence and recommend whether depression should be elevated to the status of a risk factor for patients with acute coronary syndrome. Methods and Results—: Writing group members were approved by the American Heart Association’s Scientific Statement and Manuscript Oversight Committees. A systematic literature review on depression and adverse medical outcomes after acute coronary syndrome was conducted that included all-cause mortality, cardiac mortality, and composite outcomes for mortality and nonfatal events. The review assessed the strength, consistency, independence, and generalizability of the published studies. A total of 53 individual studies (32 reported on associations with all-cause mortality, 12 on cardiac mortality, and 22 on composite outcomes) and 4 meta-analyses met inclusion criteria. There was heterogeneity across studies in terms of the demographic composition of study samples, definition and measurement of depression, length of follow-up, and covariates included in the multivariable models. Despite limitations in some individual studies, our review identified generally consistent associations between depression and adverse outcomes. Conclusions—: Despite the heterogeneity of published studies included in this review, the preponderance of evidence supports the recommendation that the American Heart Association should elevate depression to the status of a risk factor for adverse medical outcomes in patients with acute coronary syndrome.

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  • Higher levels of depression and anxiety symptoms are linked to increased risk of recurrent cardiac events and mortality following acute coronary syndrome.

    “Elevated depressive and anxiety symptoms increase the risk for recurrent cardiac events and mortality after ACS [2].”

    From Lower distress tolerance is associated with greater anxiety and depression symptoms among patients after acute coronary syndrome (2021) · cites this paper as [2]

    The sections on cardiac mortality and composite mortality/nonfatal events report associations between depressive symptoms and adverse outcomes after ACS, including recurrent nonfatal MI. The passages found do not establish the same claim for anxiety symptoms; anxiety appears as a variable in some analyses, not as a supported predictor of these outcomes. Page numbers are unavailable in our copy. (LLM, conf=0.88)

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  • One in five patients with ischaemic heart disease develop comorbid depression or anxiety.

    “One in five patients with ischaemic heart disease (IHD) develop comorbid depression or anxiety.”

    From Efficacy and cost-effectiveness of a therapist-assisted web-based intervention for depression and anxiety in patients with ischemic heart disease attending cardiac rehabilitation [eMindYourHeart trial]: a randomised controlled trial protocol (2021) · cites this paper as [3]

    The opening paragraph (indexed under Abstract; page unavailable) says approximately 20% of patients hospitalized for acute coronary syndrome meet criteria for major depression. That supports the one-in-five figure for a narrower group, but not for all patients with ischaemic heart disease; the passage does not give a rate for anxiety or establish that these conditions develop after heart disease. (LLM, conf=0.87)

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Research works printed but not linked: 3

  1. [2]2. Thombs BD, Bass EB, Ford DE, Stewart KJ, Tsilidis KK, Patel U, Fauerbach JA, Bush DE, Ziegelstein RC. Prevalence of depres- sion in survivors of acute myocardial infarction. J Gen Intern Med. 2006;21:30-38.
  2. [5]5. Centers for Disease Control and Prevention. Current depression among adults: United States, 2006 and 2008 [published correction appears in MMWR Morb Mortal Wkly Rep. 2011;60:518]. MMWR Morb Mortal Wkly Rep. 2010;59:1229-1235.
  3. [50]50. Frasure-Smith N, Lespérance F, Talajic M. Depression following myocar- dial infarction: impact on 6-month survival [published correction appears in JAMA. 1994;271:1082]. JAMA. 1993;270:1819-1825.

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Authors
Lichtman, J. H., Froelicher, E. S., Blumenthal, J. A., Carney, R. M., Doering, L. V., Frasure-Smith, N., Freedland, K. E., Jaffe, A. S., Leifheit-Limson, E. C., Sheps, D. S., Vaccarino, V., & Wulsin, L.
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2014-03-25
Volume
129
Issue
12
Pages
1350-1369
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/cir.0000000000000019
OpenAlex
W2137977071
Cited by
1,208
References
129
Citations by year
2026: 65 · 2025: 87 · 2024: 95 · 2023: 106 · 2022: 107 · 2021: 100 · 2020: 108 · 2019: 105 · 2018: 112 · 2017: 90 · 2016: 113 · 2015: 86 · 2014: 32
FWCI
17.24
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Funders
American Heart Association
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords
depression, acute coronary syndrome, cardiovascular risk factors, prognosis, all-cause mortality, cardiac mortality
MeSH terms
American Heart Association, Cardiology, Depression, Humans, Prognosis, Risk Factors, United States, Practice Guidelines as Topic, Evidence-Based Medicine, Acute Coronary Syndrome

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