Risk of Death Tied to Post-Heart Attack Depression Lessens Over Years

Patients who become depressed after heart attack have been shown to have an increased risk of dying in subsequent months, but now researchers report that risk evens out on down the road.

Johns Hopkins researchers have found 20% of patients have mild to moderate depression after heart attack. An earlier study by Duke researchers showed that these depressed patients had a fourfold increased risk of dying, but the current study of 280 heart attack patients shows that risk of dying evens out over three, five, and eight years.

"The good news is that depression after a heart attack doesn't provide a lifelong sentence of being at higher risk for death," said Roger S. Blumenthal, director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, who commented on the study. "In the long run things come back to baseline."

The Maryland researchers examined the long-term association between depression and mortality in post-heart attack patients. The results were reported at the American College of Cardiology annual meeting.

One in five of the heart attack patients, or 56 of 280 patients, were found to have mild to moderate depression using the Beck Depression Inventory, a survey used to evaluate depression.

Patients who were depressed after experiencing a heart attack had longer hospitalizations, their hearts weren't pumping as strongly, and they reported lower social support than patients who weren't depressed.

Although there were 68 deaths after three years, 98 deaths at five years, and 136 deaths at eight years, depressed patients did not have an increased rate of death compared with other heart attack patients.

"Depression is a very important risk factor after heart attack," Kapil Parakh, MPH, of Johns Hopkins Bayview Medical Center tells WebMD. "We have shown in previous groups that depression after heart attack increases the risk of death in the next few months, but as the years go by depression is no longer associated with mortality."

While depression is an important risk factor for death after heart attack, depression appears to have the greatest impact in the immediate months after heart attack, Parakh says. "It's important to treat patients with depression."

Blumenthal says it is unknown whether those patients at high risk have died or whether the depression, like that after the death in the family, subsides in time.

"Either way that short-term risk doesn't appear to be maintained," he says. "Family members must remember that heart attack is a traumatic event that can cause depression. It can influence lifestyle habits and compliance in taking medications.

"Friends and family should alert the physician to depression in a heart attack patient," he notes.