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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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Schoormans, D., Widdershoven, J. W. M. G., & Mommersteeg, P. M. C. (2020) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2020.100088 · Cited by 2
Petyunina, O. V., Kopytsya, M. P., Berezin, A. Е., & Skrynnyk, O. V. (2020) · Future Cardiology · doi:10.2217/fca-2019-0082 · Cited by 2
Garganeeva, N. P., Kornetov, N. A., & Белокрылова, М. Ф. (2020) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2020-4040 · Cited by 2
¿Es útil la intervención psicológica en las Unidades de Rehabilitación Cardíaca?
Lázaro, E. V. (2021) · Análisis y Modificación de Conducta · doi:10.33776/amc.v47i175.4950 · Cited by 2
Kubota, H., Yamada, H., Sugimoto, T., Wada, N., Motoyama, S., Saburi, M., Miyawaki, D., Wakana, N., Kami, D., Ogata, T., et al. (2022) · Cells · doi:10.3390/cells11040732 · Cited by 2
Ayari, H., & Zeller, M. (2023) · European Journal of Mental Health · doi:10.5708/ejmh.18.2023.0005 · Cited by 2
The emotional burden of living with ischaemic heart disease: an artistic approach
O’Keefe-McCarthy, S., Mussie, I., Taplay, K., Michaelson, H. L., & Faleiro, R. (2023) · British Journal of Cardiac Nursing · doi:10.12968/bjca.2022.0134 · Cited by 2
A Biopsychosocial Model Predicting Myocardial Infarction
Tomás, J. M., Oliver, A., Torres, Z., Parker, J. S., Marqués‐Sulé, E., & Sentandreu‐Mañó, T. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12175715 · Cited by 2
“Our results support previous findings that depression increases the mortality and morbidity of cardiovascular disease [78], such as those of the American Heart Association, which concluded that depression should be considered a risk factor for poor prognosis among patients with acute coronary syndrome [79].”
ResultBouchard, K., Chiarelli, A., Dans, M., & Tulloch, H. E. (2023) · Advances in biochemistry in health and disease · doi:10.1007/978-3-031-39928-2_19 · Cited by 2
Dolapoğlu, N., Dolapoğlu, A., & Tuğ, T. (2024) · Medicine · doi:10.1097/md.0000000000039941 · Cited by 2
Freiberger, A., Andonian, C., Beckmann, J., Freilinger, S., Ewert, P., Henningsen, P., Kaemmerer, H. M., Kohls, N., Richter, C., & Huber, M. (2024) · International Journal of Behavioral Medicine · doi:10.1007/s12529-024-10332-z · Cited by 2
Li, C., Wang, W., Wikström, L., & Mårtensson, J. (2024) · Asian Journal of Social Health and Behavior · doi:10.4103/shb.shb_179_24 · Cited by 2
Ding, X., Shi, Z., Xiang, L., Liu, Q., Wu, L., Long, Q., & Lee, Y. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1469980 · Cited by 2
Kenny, E., McEvoy, J. W., McSharry, J., Taylor, R. S., & Byrne, M. (2024) · Translational Behavioral Medicine · doi:10.1093/tbm/ibae068 · Cited by 2
Jing Hua, H. U., Zhuo, L., Zuo, J., Zhou, T., Lin, F., Zhao, H.-Y., Zhang, C., Wang, W., Wang, G., & Feng, L. (2025) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2025.02.014 · Cited by 2
A PSYCHOSOMATIC VICIOUS CIRCLE OF MYOCARDIAL INFARCTION
Таратухин, Е. О., Gordeev, I. G., & Lebedeva, A. Y. (2018) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2018-1-83-88 · Cited by 2
Franzon, J., Haren, M. T., Kourbelis, C., Marin, T. S., Newman, P., Jones, M., Muir‐Cochrane, E., & Clark, R. A. (2018) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2017-003487 · Cited by 2
Assessment of the effectiveness of treatment in patients after acute coronary syndrome
Швец, Д. А., Povetkin, S. V., Karasev, A. Y., & Vishnevsky, V. I. (2020) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2020-2-3405 · Cited by 2
Kim, H. J., & Song, Y. (2020) · Journal of Korean Academy of Fundamentals of Nursing · doi:10.7739/jkafn.2020.27.4.387 · Cited by 2
Amni, R., Akbar, Y., Nuraeni, A., & Akbar, M. R. (2022) · Jurnal Keperawatan · doi:10.35874/jkp.v20i3.1063 · Cited by 2
Ballegaard, S., Bergmann, N. C., Karpatschof, B., Kristiansen, J., Gyntelberg, F., Arendt‐Nielsen, L., Bech, P., Hjalmarson, Å. C., & Faber, J. O. (2016) · Journal of Behavioral and Brain Science · doi:10.4236/jbbs.2016.68031 · Cited by 2
“In healthy people, depression and depressive mood are associated with increased risk of developing IHD [4], and for the patient with IHD, depression is associated with a higher risk of adverse cardiac events [5].”
BackgroundDepression, Anxiety, and Stress
Wasson, L. T., Emeruwa, I. O., & Davidson, K. W. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-42880-4.00026-1 · Cited by 2
El afecto negativo como factor emocional de orden superior en pacientes cardiovasculares
Lemos, M., & Agudelo-Vélez, D. M. (2018) · Acta Colombiana de Psicología · doi:10.14718/acp.2018.21.2.4 · Cited by 3
Henriksson, C., Wernroth, M.-L., & Christersson, C. (2018) · Journal of Cardiology and Cardiovascular Medicine · doi:10.29328/journal.jccm.1001027 · Cited by 2
“These patients who experience anxiety and depression are at higher risk of complications [4,10,32,] and mortality [6-8].”
BackgroundEpidemiological evidence linking stress and depression with CVD
Rutledge, T. R., & Gould, H. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-815015-3.00002-7 · Cited by 2
O'Neil, A. E., Scovelle, A. J., Thomas, E. E., Russell, J. D., Taylor, C. B., Hare, D. L., Toukhsati, S. R., Oldroyd, J. C., Rangani, W. P. T., Dheerasinghe, A., et al. (2020) · Heart Lung and Circulation · doi:10.1016/j.hlc.2020.03.001 · Cited by 2
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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