Reduced positive affect (anhedonia) is independently associated with 7-year mortality in patients treated with percutaneous coronary intervention: results from the RESEARCH registry

Abstract

Aims: Negative mood states (e.g., anxiety and depression) have been associated with increased cardiovascular morbidity and mortality in coronary artery disease (CAD), but little is known about the impact of positive emotions on these health outcomes. We examined whether anhedonia (i.e., reduced positive affect) was associated with 7-year mortality in patients treated with percutaneous coronary intervention (PCI).

Methods: Consecutive PCI patients (n = 1206; 71.5% men; mean age 62.0 ± 11.1 years) from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry completed the Hospital Anxiety and Depression Scale (HADS) to assess anhedonia at baseline. Anhedonia was defined as a score ≤7 (i.e., one SD below the mean) on the positive affect scale of the HADS. The endpoint was defined as all-cause mortality.

Results: The prevalence of anhedonia was 23.7% (286/1206). After a median follow up of 7.0 ± 1.6 years, 186 deaths (15.4%) from any cause were recorded. The incidence of mortality in anhedonic patients was 22.7% (65/286) vs. 13.2% (121/920) in non-anhedonic patients (HR = 1.66, 95% CI [1.19–2.32], p = 0.003). Cumulative hazard functions were significantly different for anhedonic vs. non-anhedonic patients (log-rank χ²= 16.61, p < 0.001). In multivariable analysis, anhedonia remained independently associated with all-cause mortality (HR = 1.51, 95% CI [1.03–2.22], p = 0.036), after adjusting for socio-demographics, clinical characteristics, and negative and relaxed affect.

Conclusion: Anhedonia was independently associated with a 1.5-fold increased risk for all-cause mortality in patients who survived the first 6 months post-PCI. Enhancing positive emotions, in addition to reducing negative emotions, may constitute an important target for future psychological intervention trials in CAD patients.

Keywords

All-cause mortality anhedonia coronary artery disease percutaneous coronary intervention

Get full access to this article

View all access options for this article.

References

Januzzi

Jr. Stern

Pasternak

. The influence of anxiety and depression on outcomes of patients with coronary artery disease. Arch Intern Med 2000; 160(13): 1913–1921.

Astin

Jones

Thompson

. Prevalence and patterns of anxiety and depression in patients undergoing elective percutaneous transluminal coronary angioplasty. Heart Lung 2005; 34(6): 393–401.

Strik

JJMH

Denollet

Lousberg

. Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction. J Am Coll Cardiol 2003; 42(10): 1801–1807.

Denollet

Pedersen

Daemen

. Reduced positive affect (anhedonia) predicts major clinical events following implantation of coronary-artery stents. J Intern Med 2008; 263(2): 203–211.

Brummett

Boyle

Siegler

. Ratings of positive and depressive emotion as predictors of mortality in coronary patients. Int J Cardiol 2005; 100(2): 213–216.

Pressman

Cohen

. Does positive affect influence health? Psychol Bull 2005; 131(6): 925–971.

Tellegen

Watson

Clark

. On the dimensional and hierarchical structure of affect. Psychol Sci 1999; 10(4): 297–303.

Larsen

McGraw

Cacioppo

. Can people feel happy and sad at the same time? J Pers Soc Psychol 2001; 81(4): 684–696.

Middleton

Byrd

. Psychosocial factors and hospital readmission status of older persons with cardiovascular disease. J Appl Rehabil Counsel 1996; 27(4): 3–10.

10.

Smart Richmann

Kubzansky

Maselko

. Positive emotion and health: going beyond the negative. Health Psychol 2005; 24(4): 422–429.

11.

Rozanski

Kubzansky

. Psychologic functioning and physical health: a paradigm of flexibility. Psychosom Med 2005; 67(Supplement 1): S47–S53.

12.

Davidson

Mostofsky

Whang

. Don’t worry, be happy: positive affect and reduced 10-year incident coronary heart disease: the Canadian Nova Scotia Health Survey. Eur Heart J 2010; 31(9): 1065–1070.

13.

Kubzansky

Sparrow

Vokonas

. Is the glass half empty or half full? A prospective study of optimism and coronary heart disease in the normative aging study. Psychosom Med 2001; 63(6): 910–916.

14.

Davidson

Burg

Kronish

. Association of anhedonia with recurrent major adverse cardiac events and mortality 1 year after acute coronary syndrome. Arch Gen Psychiatry 2010; 67(5): 480–488.

15.

Versteeg

Pedersen

Erdman

. Negative and positive affect are independently associated with patient-reported health status following percutaneous coronary intervention. Qual Life Res 2009; 18(8): 953–960.

16.

Pelle

Pedersen

Erdman

. Anhedonia is associated with poor health status and more somatic and cognitive symptoms in patients with coronary artery disease. Qual Life Res 2011; 20(5): 643–651.

17.

Lemos

Serruys

van Domburg

. Unrestricted utilization of sirolimus-eluting stents compared with conventional bare stent implantation in the ‘real world’: the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. Circulation 2004; 109(2): 190–195.

18.

Ong

ATL

van Domburg

Aoki

. Sirolimus-eluting stents remain superior to bare-metal stents at two years: medium-term results from the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) registry. J Am Coll Cardiol 2006; 47(7): 1356–1360.

19.

Pedersen

Denollet

Ong

. Impaired health status in Type D patients following PCI in the drug-eluting stent era. Int J Cardiol 2007; 114(3): 358–365.

20.

Rumsfeld

Magid

Plomondon

. Veterans affairs angina with extremely serious operative mortality investigators. health-related quality of life after percutaneous coronary intervention versus coronary bypass surgery in high-risk patients with medically refractory ischemia. J Am Coll Cardiol 2003; 41(10): 1732–1738.

21.

Goodyear

MDE

Krleza-Jeric

Lemmens

. The Declaration of Helsinki. Br Med J 2007; 335(7621): 624–625.

22.

Zigmond

Snaith

. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67(6): 361–370.

23.

Spinhoven

Ormel

Sloekers

. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med 1997; 27(2): 363–370.

24.

Martin

Lewin

RJP

Thompson

. A confirmatory factor analysis of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction. Psychiatry Res 2003; 120(1): 85–94.

25.

Emons HM KS and Pedersen SS. Dimensionality of the Hospital Anxiety and Depression Scale (HADS) in cardiac patients: comparison of Mokken Scale Analysis and Factor Analysis. Assessment 2010 [epublication ahead of print].

26.

Dunbar

Ford

Hunt

. A confirmatory factor analysis of the Hospital Anxiety and Depression scale: comparing empirically and theoretically derived structures. Br J Clin Psychol 2000; 39(1): 79–94.

27.

Snaith

Zigmond

. The hospital anxiety and depression scale. Br Med J 1986; 292(6516): 344–344.

28.

Babyak

. What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models. Psychosom Med 2004; 66(3): 411–421.

29.

Freedland

Babyak

McMahon

. Statistical guidelines for psychosomatic medicine. Psychosom Med 2005; 67(2): 167–167.

30.

Peduzzi

Concato

Kemper

. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996; 49(12): 1373–1379.

31.

Steptoe

O’Donnell

Badrick

. Neuroendocrine and inflammatory factors associated with positive affect in healthy men and women. Am J Epidemiol 2008; 167(1): 96–102.

32.

Berkman

Blumenthal

Burg

. Enhancing Recovery in Coronary Heart Disease Patients Investigators (ENRICHD). Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. J Am Med Assoc 2003; 289(23): 3106–3116.

33.

Frasure-Smith

Prince

. The ischemic heart disease life stress monitoring program: impact on mortality. Psychosom Med 1985; 47(5): 431–445.

34.

Blumenthal

Sherwood

Babyak

. Effects of Exercise and Stress Management Training on Markers of Cardiovascular Risk in Patients With Ischemic Heart Disease. J Am Med Assoc 2005; 293(13): 1626–1634.

35.

Strachowski

Khaylis

Conrad

. The effects of cognitive behavior therapy on depression in older patients with cardiovascular risk. Depress Anxiety 2008; 25(8): E1–E10.

36.

Grossman

Tiefenthaler-Gilmer

Raysz

. Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3-year follow-up benefits in well-being. Psychother Psychosom 2007; 76(4): 226–233.

37.

Pedersen

Denollet

van Gestel

. Clustering of psychosocial risk factors enhances the risk of depressive symptoms 12-months post percutaneous coronary intervention. Eur J Cardiovasc Prev Rehabil 2008; 15(2): 203–209.

38.

Rozanski

Blumenthal

Davidson

. The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol 2005; 45(5): 637–651.

39.

Pedersen

van den Broek

Erdman

RAM

. Pre-implantation implantable cardioverter defibrillator concerns and Type D personality increase the risk of mortality in patients with an implantable cardioverter defibrillator. Europace 2010; 12(10): 1446–1452.