By John Salak –
Heart attacks are a deadly problem that just don’t seem to let up. More than 700,000 Americans suffer an attack every year and close to 150,000 perish annually from these strikes, making them the leading cause of death of men and women in most racial and demographic groups, the Centers for Disease Control and Prevention reports. Additionally, stress harms heart attack survivors, further complicating recovery and increasing the risk of subsequent cardiac events.
The immediate danger is apparent enough. But now the American Heart Association is warning that the fear of having another heart attack is a major ongoing stressor for heart attack survivors. The related anxiety can be so severe it can undermine a patient’s long-term mental and physical health.
The association acknowledges that survivors of heart attacks can suffer from depression or anxiety, but little focus has been put on the impact of psychological stress on their extended well-being and recovery. The group’s study moved to close this gap.
“We wanted to understand what survivors thought about the possibility of another heart attack. Specifically, we examined how demographics, health behaviors and the patient’s perception of their illness predicted both fear of having another heart attack and perception of their current stress,” said lead study author Sarah Zvonar, a post-doctoral fellow at Indiana University.
The research team undertook its work by recruiting people who had experienced a heart attack during a one-year period between 2021-2022. Those who responded were directed to a newly created Facebook group with links to standard questionnaires that assessed fear of recurrence, perceptions of their illness, current stress, anxiety and depression. Participants also provided demographic details and information on their current cardiovascular-related health behaviors.
The researchers analyzed data for more than 170 heart attack survivors who completed the questionnaires twice, about six weeks apart approximately six and eight months after their heart attack.
The study found that the fear of experiencing another heart attack significantly impacted their level of perceived stress. Survivors also noted that their fear of another attack remained significant six and eight months after their first attack.
Although most survivors didn’t increase their alcohol, those who did were more likely to deal with greater fear of another attack and more stress. Adherence to an improved diet, no smoking and improved exercise routines also didn’t seem to offset related fears. The results, ultimately, show the critical need to refocus on how healthcare professionals treat heart attack sufferers.
“Health care often focuses solely on anxiety and depression, and treatment may include antidepressants, missing an important issue—patients may be experiencing fear of having another heart attack for another reason,” Zvonar explained. “For example, there is so much new health information for them to process after a first heart attack—how to improve their diet, exercise, follow-up care, cardiac rehabilitation, etc. In addition, we found that the fear of recurrence did not diminish from six to eight months after the heart attack, which indicates that people may need extended follow-up and mental health support.”
The association acknowledged the study’s limitations. The experiences of young heart attack survivors, whose average age was less than 40, may not match older heart attack survivors. In the U.S., the average age at a first heart attack is 66 years for men and 72 years for women, the association noted. Another limitation was that race and ethnicity were not sufficiently represented.
“The study needs to be replicated in a clinic with the collection of medical data. However, I would anticipate that the results would be similar,” Zvonar said.
Despite the study’s limitations, it is nevertheless noteworthy and something that the medical industry needs to consider, stressed Dr. Glenn N. Levine, M.D., a professor of medicine at Baylor College of Medicine and chair of the 2021 American Heart Association scientific statement.
“As health care professionals, it’s important to consider both the disease and the person. This study suggests that we should consider not only psychological factors, such as depression and stress after a heart attack but additionally recognize that many people may have a genuine fear of experiencing another heart attack, which can also have a negative impact on their psychological health. Given that poor psychological health increases the risk of future heart problems, this fear may, to some extent, become a self-fulfilling prophecy in some people,” he said.
