Mental disorders associated with increased risk of dying among people with heart disease

Breaking new ground 10. feb 2022 3 min Senior Researcher and Clinical Professor Selina Kikkenborg Berg Written by Kristian Sjøgren

A researcher wants to increase the focus on helping people with both heart disease and anxiety or depression.

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Compared with the general population, people with heart disease have an increased risk of being diagnosed with anxiety or depression.

New research in Denmark now shows that people with both heart disease and anxiety or depression or who are taking psychotropic drugs have an increased risk of dying within 1 year of hospitalisation.

According to a researcher behind the study, the results show the need for more focus on supporting people with both heart disease and anxiety or depression.

“People with heart disease who have anxiety or depression or who are being treated for anxiety or depression should be considered at high risk in relation to their heart disease. We need to take extra care of them and ensure that they get the help they need,” explains Selina Kikkenborg Berg, Senior Researcher and Professor of Cardiology, Rigshospitalet, Copenhagen.

The research has been published in the European Journal of Cardiovascular Nursing.

Many people with heart disease also have anxiety or depression

The research is based on the DenHeart survey of 12,913 residents of Denmark with heart disease.

DenHeart was established to survey how people with heart disease are doing after leaving the hospital.

Previous studies from DenHeart have shown that people with heart disease have more anxiety and depression than the general population: 30% with anxiety symptoms and 15% with symptoms of depression.

Further, previous research has found excess mortality among people with heart disease and anxiety or depression versus those without anxiety or depression.

“Most people understand that people diagnosed with heart disease may experience anxiety or depression as a common emotional reaction. However, our previous studies have shown that many already took medication for anxiety or depression before being hospitalised for heart disease. Thus, there is complex interaction between heart disease, mental disorders and medication, and we aimed to understand this better through this study,” says Selina Kikkenborg Berg.

Diverse cohort of people with heart disease studied

Through both drug registries and questionnaire surveys, the researchers determined which DenHeart participants had symptoms of anxiety or depression.

The participants had been hospitalised and discharged after treatment for ischaemic heart disease, arrhythmia, heart failure, valvular heart disease or other heart diseases. The groups did not differ much in the incidence of anxiety and depression.

In connection with hospitalisation, the participants had received various treatments for heart disease.

Some had taken drugs, others had undergone a balloon angioplasty and a third group had undergone open heart surgery.

“We mainly wanted to determine whether taking psychotropic drugs for anxiety and depression was associated with increased mortality within 1 year after treatment for heart disease. Psychotropic drugs can cause problems for people with heart disease and influence the effectiveness of heart medicine, but little evidence indicates whether they are associated with increased mortality,” explains Selina Kikkenborg Berg.

Psychotropic drugs linked with early death

Of the participants in DenHeart, 18% had taken psychotropic drugs before being hospitalised for heart disease.

Six percent of these people died within 1 year after hospitalisation versus only 2% of those not taking psychotropic drugs.

Selina Kikkenborg Berg explains that this corresponds to doubling the risk of dying within 1 year after being treated for heart disease.

However, Selina Kikkenborg Berg also emphasises that the researchers cannot conclude that the medicine causes the excess mortality.

“We want to emphasise that people with heart disease taking psychotropic drugs should definitely not experiment with stopping treatment for anxiety or depression,” she says.

Anxiety and depression trigger stress

Selina Kikkenborg Berg has various explanations for the excess mortality among people with heart disease taking psychotropic drugs.

One possibility is side-effects associated with medication. However, the researchers do not think this is likely and instead think that taking medication results from the health effects of the underlying mental disorder, and this is the problem.

“Anxiety and depression trigger stress, and stress adversely affects the heart. We think that the excess mortality results from the increased morbidity among people with mental disorders. They generally have several diseases or disorders and behaviour that creates difficulty in quitting smoking, eating healthily and exercising. All these factors adversely affect heart health,” explains Selina Kikkenborg Berg.

Dying from the same cause but earlier

The researchers followed up by studying the causes of death in the people with heart disease being treated for anxiety versus those without mental disorders and found no difference.

“We therefore think that people with heart disease and anxiety or depression die earlier because their mental disorder accelerates their systemic disease situation. They would probably die from the same thing later if they did not also have anxiety or depression,” says Selina Kikkenborg Berg.

More focus on vulnerable people

Selina Kikkenborg Berg thinks that the new results indicate the need for improving the approach towards people with both heart disease and anxiety or depression.

The data suggest that healthcare professionals should pay more attention to these people because they probably have additional needs.

They may need to be followed up extra carefully, and professionals should be aware of their disease trajectory in relation to rehabilitation.

“They need to be offered services, such as smoking cessation, and extra support to get check-ups more frequently so that we can identify and treat any exacerbation of their heart disease. They also require extra attention so they do not become sedentary at home. People who have symptoms of anxiety or depression but are not being treated with psychotropic drugs should also be offered treatment for their mental disorder, either with medication or with therapy,” concludes Selina Kikkenborg Berg.

Exploring the use of psychotropic medication in cardiac patients with and without anxiety and its association with 1-year mortality” has been published in the European Journal of Cardiovascular Nursing. The Novo Nordisk Foundation awarded grants to Selina Kikkenborg Berg in 2018 for the project Heart and Mind and in 2020 through its emergency coronavirus programme.

Cardiac nursing Psychocardiology Cardiac rehabilitation RCT/survey/register research Project DenHeart, Project Heart&Mind, Project HeartBuddy

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