DALLAS – Fear of recurrence is a major ongoing stressor for heart attack survivors, according to a preliminary study to be presented at the 2024 Scientific Sessions of the American Heart Association (AHA 2024).
“While it is widely recognized that heart attack survivors may suffer from depression or anxiety, the impact of psychological stress and how fear of another heart attack can impact mental recovery and emotional health of patients have received less attention,” says an AHA press release.[1].
“We wanted to understand what survivors thought about the possibility of another heart attack. Specifically, we examined how patient demographics, health behaviors, and illness perception predicted both fear of having another heart attack and perception of their current stress,” explains main author of the study, Sarah Zvonarpostdoctoral fellow at Indiana University School of Medicine in Indianapolis.
Questionnaires six and eight months after the heart attack
In practice, researchers placed ads on Facebook to recruit volunteers for the study – people who had suffered a heart attack during a one-year period between 2021 and 2022.
Those who responded were directed to a newly created Facebook group, with links to standard questionnaires that assessed fear of recurrence, perception of their illness, current stress, anxiety and depression. Participants also provided demographic data and information about their current cardiovascular health behaviors. Researchers analyzed data from 171 heart attack survivors who completed the questionnaires twice, approximately six weeks apart (approximately six and eight months after their heart attack).
Fear still present despite health and diet measures
The results of the study show that the fear of having another heart attack had a significant impact on the perception of the illness and on the level of perceived stress. Fear of another heart attack was significant six months after the heart attack and remained significant at follow-up approximately eight months later. Controlling depression and anxiety did not reduce the impact of fear of recurrence on illness perception and perceived stress between six months and approximately eight months after the initial event.
Although average alcohol consumption was low among all participants, those who consumed more alcohol seemed more likely to experience both fear of another heart attack and higher levels of perceived stress. Average alcohol consumption was 1.35 drinks per week, with a range of 1 to 6 drinks per week.
Adherence to diet, smoking, and exercise advice did not significantly predict fear of recurrence or perceived stress.
Conclusions worthy of interest
The study has several limitations. The results obtained from this group of young heart attack survivors, whose average age was less than 40 years, cannot be generalized to older heart attack survivors. Furthermore, ethnic diversity was not sufficiently represented in this study.
As healthcare professionals, it is important to consider both the disease and the person
Additionally, because the study was conducted during the Covid-19 pandemic via Facebook, it was not possible to collect and verify many clinical details (such as heart attack severity and medication use) . This means that certain factors likely to influence psychological well-being and fear of recurrence could not be analyzed, the press release states.
“Although preliminary and based on a small sample of young people who self-selected in response to a Facebook ad, the findings of this study are nevertheless worthy of interest,” considered the Dr Glenn N. Levineprofessor of medicine at Baylor College of Medicine and chair of the American Heart Association’s 2021 scientific statement, Psychological Health, Well-Being, and the Mind-Heart-Body Connection -mind-heart). “As healthcare professionals, it is 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 also recognize that many people may have a genuine fear of having another heart attack, which can also have a negative impact on their psychological health.
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