Fear of recurrence is a significant ongoing stressor for heart attack survivors. Depression and anxiety are also commonly recognized in heart attack recovery, says a new study.
The preliminary study presented at the American Heart Association’s Scientific Sessions 2024 focuses on the impact of psychological stress, specifically the fear of having another heart attack. This fear continues to affect patients’ emotional well-being even months after the initial event.
UNDERSTANDING THE IMPACT OF FEAR ON MENTAL RECOVERY
Lead author Dr. Sarah Zvonar, a post-doctoral fellow at the Indiana University School of Medicine, explained that the study aimed to explore multiple factors. These factors include demographics, health behaviors, and patients’ perceptions of their illness. They contribute to the fear of recurrence and its subsequent effects on stress levels.
“We wanted to understand what survivors thought about the possibility of another heart attack,” Zvonar said. The study aimed to uncover the psychological challenges these individuals face. It also examined the impact of their own health behaviors and perceptions on their recovery.
STUDY METHODOLOGY AND FINDINGS
Researchers recruited 171 heart attack survivors who had experienced a heart attack between 2021 and 2022. Participants were directed to an online questionnaire using Facebook advertisements. It assessed fear of recurrence, illness perception, stress, and mental health. The study found several important results:
- Fear of recurrence significantly affected participants’ perception of their illness and perceived stress. This fear was present six months after the heart attack. It remained significant even at the follow-up survey around eight months later.
- Depression and anxiety were also common. However, the fear of having another heart attack remained a major stressor. This was true even when controlling for these psychological factors.
- Participants who consumed higher amounts of alcohol experienced a greater fear of recurrence. They also experienced higher stress levels. This occurred despite overall low average alcohol intake.
- Adherence to dietary, exercise, and smoking cessation guidelines did not significantly predict fear of recurrence. These guidelines also did not predict perceived stress. This suggests that other factors, including emotional responses, may play a larger role in recovery.
EXTENDED FOLLOW-UP AND MENTAL HEALTH SUPPORT NEEDED
Dr. Zvonar emphasized that heart attack survivors may require extended mental health support beyond standard treatment, as the fear of recurrence may not diminish over time. “The fear of recurrence did not diminish from 6-8 months after the heart attack, indicating that people may need extended follow-up and mental health support,” Zvonar explained.
CHALLENGES AND LIMITATIONS OF THE STUDY
There are some limitations to the study, particularly due to its reliance on a small, younger sample group—the average age of participants was 39, much younger than the average age for a first heart attack (66 for men and 72 for women, according to the American Heart Association). The study also lacked comprehensive clinical data, such as the severity of heart attacks and medication use, and did not sufficiently represent racial or ethnic diversity.
Despite these limitations, the findings are significant, suggesting that the fear of recurrence could have a lasting effect on mental health and recovery, and should be considered alongside other psychological conditions like depression and anxiety.
THE NEED FOR COMPREHENSIVE CARE
Dr. Glenn N. Levine, a professor of medicine at Baylor College of Medicine, emphasized the importance of addressing both the physical and psychological aspects of heart attack recovery. “We should consider not only psychological factors such as depression and stress but also recognize that many survivors genuinely fear experiencing another heart attack. This fear can negatively impact their psychological health and, ultimately, their overall recovery,” Levine said. He also warned that poor psychological health could increase the risk of future heart problems, potentially creating a self-fulfilling prophecy for some individuals.
PARTICIPANT DEMOGRAPHICS AND STUDY DESIGN
The study included a diverse group of participants in terms of race and health conditions, although some demographics were underrepresented. The majority were recruited through Facebook advertising, while a smaller number were recruited from a Midwest trauma center. Key health conditions reported among participants included high blood pressure (46.2%) and Type 2 diabetes (44.4%). Many participants also exhibited unhealthy behaviors, such as insufficient physical activity and tobacco use, with only 26% having attended cardiac rehabilitation sessions.
