Antidepressants and other psychiatric medications are associated with an almost doubled risk of premature death in patients with heart conditions, according to research published today in the European Journal of Cardiovascular Nursing, a journal of the European Society of Cardiology (ESC).
Our study shows that the use of psychotropic drugs is common in those with heart disease. In addition, almost one in three patients had symptoms of anxiety. Patients with cardiac illnesses should be systematically assessed for mental disorders, and asked whether they use psychotropic medications and for what reason."
Dr Pernille Fevejle Cromhout, Study Author, Copenhagen University Hospital
"It is important to remember that being prescribed a psychotropic drug is an indication of a mental disorder, which might in itself contribute to an increased risk of death," said Dr. Cromhout. "Further research is needed to evaluate whether the higher mortality is due to the use of psychotropic medication or the underlying mental illness."
Previous studies have found an association between symptoms of anxiety and poor health outcomes, including death, in patients with cardiac disease. This study explored whether this link might be explained by the use of psychotropic medication.
The study enrolled 12,913 patients hospitalised for ischaemic heart disease, arrhythmias, heart failure or valvular heart disease from the DenHeart national survey. Participants completed a questionnaire at hospital discharge and were classified as having anxiety symptoms if they scored eight or higher on the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A).
Information on medications was obtained using national registers. Patients were defined as users of psychotropic drugs if they had collected at least one prescription during the six months prior to hospital admission of benzodiazepines, benzodiazepine-like drugs, antidepressants or antipsychotics. Patients were followed-up for one year following hospital discharge for all-cause death.
The researchers found that 2,335 participants (18%) redeemed at least one prescription for psychotropic medication during the six months prior to hospital admission. The most commonly used drugs were benzodiazepines (68%) and antidepressants (55%). Use of psychotropic medications was higher among women, older patients, smokers, widowed patients, those with less education, and patients with greater numbers of co-existing health problems.
Nearly one-third of cardiac patients (32%) were classified as having anxiety. Psychotropic drug use was twice as high in patients with anxiety (28%) compared to those without anxiety (14%).
A total of 362 patients (3%) died within the first year after discharge from hospital. The one-year death rate was significantly higher in users of psychotropic medication (6%) compared with non-users (2%). Redeeming a prescription for psychotropic medication within the six months prior to hospitalisation was associated with 1.90 higher odds of all-cause death during the year post-discharge after adjusting for age, sex, cardiac diagnosis, co-existing conditions, smoking status, body mass index, education level and marital status. The presence of anxiety was associated with a 1.81 higher odds of all-cause death during the same time period.
When the analyses were also adjusted for the use of psychotropic medication prior to hospitalisation and the presence of anxiety, the associations became weaker. Use of psychotropic medication was associated with 1.73 higher odds of death and anxiety with 1.67 higher odds of death. Dr. Cromhout explained: "The weakening of the relationships suggests that the link between psychotropic medications and death is influenced by the presence of anxiety. And, similarly, that the connection between anxiety and death is influenced by the use of psychotropic medications."
She continued: "Patients with heart disease who suffer from anxiety should inform the healthcare professionals involved in their treatment as they would do with any other co-existing condition. They should also ask that their anxiety is recognised as important and equal to their heart disease."
Cromhout, P. F., et al. (2021) Exploring the use of psychotropic medication in cardiac patients with and without anxiety and its association with 1-year mortality. European Journal of Cardiovascular Nursing. doi.org/10.1093/eurjcn/zvab111.