In-hospital distress can predict heart attack outcomes

March 22, 2000

People who are depressed and anxious in the hospital after a heart attack are more likely than other heart attack patients to have ongoing distress and poorer quality of life, a new study concludes.

"We looked at depression and anxiety in more than 220 myocardial infarction, or heart attack, patients over the course of a year and found that those who were distressed continued to be distressed and had poorer outcomes," said lead author Richard Anthony Mayou, BM, MA, FRCP, FRCPsych, of the University of Oxford's Department of Psychiatry.

In the study, 344 myocardial infarction hospital patients in Oxfordshire, England, completed a questionnaire while in the hospital and again at three and 12 months after leaving the hospital. At three months, 243 of the patients (71 percent of the original sample) responded, and at 12 months, 224 of the patients (65 percent of the original sample) responded. Scores were computed for depression and anxiety, two components of distress.

Distressed patients' depression and anxiety decreased during the first three months but did not improve any further by 12 months. At both survey times, their average scores for both anxiety and depression were higher than those for the non-distressed group. When compared at three and 12 months to the non-distressed patients, distressed patients reported more chest pain; poorer overall quality of life; less progress in making positive lifestyle changes related to exercise, diet, and smoking; and greater use of health care services, including primary care and emergency room visits.

Those who were distressed during the hospital stay also had significantly longer hospital stays, were younger, and were more likely to be smokers. No correlation was found between baseline distress and death.

"The study results suggest that monitoring and early treatment for depression and anxiety could substantially improve outcomes and patients' well-being," Mayou said. "Those with depression and anxiety in the hospital should be seen as requiring special attention."

Published in the latest issue of Psychosomatic Medicine, the research was funded by the National Health Service Research and Development Program for Cardiovascular Disease and Stroke and the Oxfordshire District Health Authority in England.
Psychosomatic Medicine, published bimonthly, is the official peer-reviewed journal of the American Psychosomatic Society. For information about the journal, contact Joel E. Dimsdale, MD, at (619) 543-5468.

Posted by the Center for the Advancement of Health For information about the Center, call Petrina Chong, (202) 387-2829.

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