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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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Lin, S., Zhang, H., & Ma, A. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.02.027 · Cited by 15
O'Neil, A. E., Fisher, A. J., Kibbey, K. J., Jacka, F. N., Kotowicz, M. A., Williams, L. J., Stuart, A. L., Berk, M., Lewandowski, P. A., Atherton, J. J., et al. (2016) · Preventive Medicine · doi:10.1016/j.ypmed.2016.02.028 · Cited by 15
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The mechanisms by which antidepressants may reduce coronary heart disease risk
Mathews, M. J., Mathews, E. H., & Liebenberg, L. (2015) · BMC Cardiovascular Disorders · doi:10.1186/s12872-015-0074-5 · Cited by 15
The Risk of Thromboembolism in Users of Antidepressants and Antipsychotics
Adelborg, K., Sundbøll, J., Videbech, P., & Grove, E. L. (2016) · Advances in experimental medicine and biology · doi:10.1007/5584_2016_125 · Cited by 15
Depressive Symptoms and Risk for Sudden Cardiac Death in Stable Coronary Artery Disease
Lahtinen, M., Kiviniemi, A. M., Junttila, J. M., Kääriäinen, M., Huikuri, H. V., & Tulppo, M. P. (2018) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2018.05.006 · Cited by 15
Screening for symptoms of depression and anxiety in a cardiology department.
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“Ifølge American Heart Association (7) er depresjon en negativ prognostisk faktor i alle faser av sykdomsforløpet (8).”
InfluentialLim, Y., Choi, Y., Kang, E. S., Jeong, Y., Park, J., & Han, H. W. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.03.164 · Cited by 14
for the SPIRR-CAD Investigators, Meyer, T., Rothe, I., Staab, J., Deter, H., Fangauf, S. V., Hamacher, S., Hellmich, M., Jünger, J., Ladwig, K., et al. (2020) · Biochemical Genetics · doi:10.1007/s10528-020-09967-w · Cited by 14
Stress and Cardiovascular Disease: The Role of Affective Traits and Mental Disorders
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“First, over 20% of older women with CVD are estimated to have high levels of depressive symptoms [36-38] that may suppress serum biomarkers associated with cognition [39].”
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Transforming Cardiovascular Disease Prevention in Women: Time for the Pygmalion Construct to End
WENGER, N. K. (2014) · Cardiology · doi:10.1159/000370018 · Cited by 14
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The prognostic role of depression as a predictor of chronic somatic diseases manifestation.
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on behalf of the CoRe-Net study group, Peltzer, S., Müller, H., Köstler, U., Blaschke, K., Schulz‐Nieswandt, F., Jessen, F., & Albus, C. (2019) · BMC Psychology · doi:10.1186/s40359-019-0295-y · Cited by 14
Residual Symptoms After Treatment for Depression in Patients With Coronary Heart Disease
Carney, R. M., Freedland, K. E., Steinmeyer, B. C., Rubin, E. H., & Rich, M. W. (2018) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000570 · Cited by 14
“The purpose of this studywas to identify the symptoms that persist despite aggressive treatment for depression in patients with CHD. Methods: One hundred twenty-five patients with stable CHD who met the DSM-IV criteria for a moderate-to-severe major depressive episode completed treatment with cognitive behavior therap…”
BackgroundInfluentialSelf-citationMental Disorders as a Risk Factor of Acute Coronary Syndrome
Gupta, A., Tejpal, T., Seo, C., Fabiano, N., Zhao, S., Wong, S., Qiu, Y., MacNeil, J. L., Kim, D. R., Aleksova, N., et al. (2026) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2025.4253 · Cited by 13
Primary PCI and Mental Health: A 12-Month Follow-Up Study
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“summarized several studies that found a significant association between depression and anxiety in post-AMI patients [63].”
BackgroundNon-destructive detection of CAD stenosis severity using ECG-PCG coupling analysis
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Agarwal, S., Wagner, M. K., & Mion, M. (2024) · Neurotherapeutics · doi:10.1016/j.neurot.2024.e00509 · Cited by 15
Depression leads to incident vascular disease: evidence for the relevance to primary care
Scherrer, J. F., Salas, J., Brieler, J. A., Miller, B. J., Meyer, D. D., & Schneider, D. (2015) · Family Practice · doi:10.1093/fampra/cmu092 · Cited by 13
Gerber, M. R., King, M. W., Iverson, K. M., Pineles, S. L., & Haskell, S. G. (2017) · Journal of Women s Health · doi:10.1089/jwh.2017.6328 · Cited by 13
“This connection has recently gained attention as a public health problem; in February 2014, the American Heart Association (AHA) issued a statement identifying depression as a risk factor for adverse medical outcomes in patients with acute coronary syndrome.(16) Accumulating longitudinal data suggest that depression i…”
InfluentialDepression and Cardiovascular Disease in Women
Rivera, M. A. M., Rivera, I. R., Ávila, W. S., Marques-Santos, C., Costa, F. A., Ferro, C. R. C., & Fernandes, J. M. G. (2022) · International Journal of Cardiovascular Sciences · doi:10.36660/ijcs.20200416 · Cited by 13
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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