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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 accessAbstract
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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“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]
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“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]
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BackgroundAntidepressant Drugs Effects on Blood Pressure
Calvi, A., Fischetti, I., Verzicco, I., Murri, M. B., Zanetidou, S., Volpi, R., Coghi, P., Tedeschi, S., Amore, M., & Cabassi, A. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.704281 · Cited by 153
O’Neil, A., Jacka, F. N., Quirk, S. E., Cocker, F., Taylor, C. B., Oldenburg, B., & Berk, M. (2015) · BMC Psychiatry · doi:10.1186/s12888-015-0394-0 · Cited by 135
“Thus, the American Heart Association recently recognized depression as a risk factor for poor prognosis following a cardiac event [16].”
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Lavie, C. J., Menezes, A. R., Schutter, A. D., Milani, R. V., & Blumenthal, J. A. (2016) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2016.07.508 · Cited by 159
Self-citationDepression Treatment and 1-Year Mortality After Acute Myocardial Infarction
Smolderen, K. G. E., Buchanan, D. M., GOSCH, K. L., Whooley, M. A., Chan, P. S., Vaccarino, V., Parashar, S., Shah, A. J., Ho, P. M., & Spertus, J. A. (2017) · Circulation · doi:10.1161/circulationaha.116.025140 · Cited by 135
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Mental Stress and Cardiovascular Health—Part I
Vancheri, F., Longo, G., Vancheri, E., & Henein, M. Y. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11123353 · Cited by 147
Gender-Based Differences in Anxiety and Depression Following Acute Myocardial Infarction
Šerpytis, P., Navickas, P., Lukavičiūtė, L., Navickas, A., Aranauskas, R., Šerpytis, R., Deksnytė, A., Glaveckaitė, S., Petrulionienė, Ž., & Samalavicius, R. S. (2018) · Arquivos Brasileiros de Cardiologia · doi:10.5935/abc.20180161 · Cited by 120
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Smolderen, K. G. E., Strait, K. M., Dreyer, R. P., D’Onofrio, G., Zhou, S., Lichtman, J. H., Geda, M. E., Bueno, H., Beltrame, J. F., Safdar, B., et al. (2015) · Journal of the American Heart Association · doi:10.1161/jaha.114.001424 · Cited by 115
Self-citationYu, B., Steptoe, A., Chen, L.-J., Chen, Y.-H., Lin, C.-H., & Ku, P.-W. (2020) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000777 · Cited by 108
Depression and anxiety in patients with different rare chronic diseases: A cross-sectional study.
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“Further, associations between depression, anxiety, and cardiovascular outcomes are likely to be reduced due to regression dilution bias [11].”
BackgroundPimple, P. M., Lima, B. B., Hammadah, M., Wilmot, K. A., Ramadan, R., Levantsevych, O. M., Sullivan, S. M., Kim, J. H., Kaseer, B., Shah, A. J., et al. (2019) · Journal of the American Heart Association · doi:10.1161/jaha.118.011866 · Cited by 109
Self-citationZambrano, J., Celano, C. M., Januzzi, J. L., Massey, C. N., Chung, W., Millstein, R. A., & Huffman, J. C. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.120.018686 · Cited by 120
Anxiety and depression among out-of-hospital cardiac arrest survivors
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Depression and cardiovascular disease: an update on how course of illness may influence risk
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“The American Heart Association (AHA) recently released a scientific statement elevating depression to the status of a risk factor for patients with acute coronary syndromes [1].”
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“A meta-analysis indicates that the risk of low cardiovascular prognosis is almost doubled by depression after MI (Lichtman et al. 2014).”
BackgroundHuffman, J. C., Millstein, R. A., Mastromauro, C. A., Moore, S. V., Celano, C. M., Bedoya, C. A., Suarez, L., Boehm, J. K., & Januzzi, J. L. (2016) · Journal of Happiness Studies · doi:10.1007/s10902-015-9681-1 · Cited by 102
“depression is considered by the American Heart Association to be a risk factor for poor prognosis following an ACS (Lichtman et al. 2014), possibly due to the known associations of depression with nonadherence to diet, physical activity, medications, and other key secondary prevention measures (Ziegelstein et al.”
InfluentialDepression and anxiety symptoms as predictors of mortality in PCI patients at 10 years of follow-up
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“Our results support the recently published statement regarding depression by the American Heart Association (AHA).(29) The AHA conducted a systematic review on depression and poor prognosis among patients with acute coronary syndrome (ACS), concluding that health organizations should consider depression as an official…”
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Cardiovascular disease and depression: a narrative review
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“Up to 40% of these patients experience symptoms of anxiety and depression 10 , contributing to independent risk factors for cardiac mortality and morbidity 11, 12 .”
BackgroundBrain-heart connections in stress and cardiovascular disease: Implications for the cardiac patient
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Self-citationAntihypertensive Drugs and Risk of Depression
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Psychosocial stress and major cardiovascular events in patients with stable coronary heart disease
Hagström, E., Norlund, F., Stebbins, A. S., Armstrong, P. W., Chiswell, K., Granger, C. B., López-Sendón, J., Pella, D., Soffer, J., Sy, R., et al. (2017) · Journal of Internal Medicine · doi:10.1111/joim.12692 · Cited by 97
Ghezzi, P., Floridi, L., Boraschi, D., Cuadrado, A., Manda, G., Levic, S., D’Acquisto, F., Hamilton, A., Athersuch, T. J., & Selley, L. (2017) · Antioxidants and Redox Signaling · doi:10.1089/ars.2017.7147 · Cited by 95
Metadata
- 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
- Published
- 2014-03-25
- Volume
- 129
- Issue
- 12
- Pages
- 1350-1369
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- 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
- bronze
- doi.org
- 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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