A preliminary study to be presented at the American Heart Association's Scientific Sessions 2024 has uncovered that fear of experiencing another heart attack is a significant ongoing stressor for survivors, impacting their perception of illness and stress levels. The study, led by Sarah Zvonar, Ph.D., R.N., C.C.R.N., a post-doctoral fellow at the Indiana University School of Medicine, analyzed data from 171 heart attack survivors who completed questionnaires at approximately six and eight months after their initial heart attack. The research team found that the fear of recurrence significantly influenced participants' illness perception and perceived stress levels, even when controlling for depression and anxiety.
Notably, this fear persisted from the six-month mark to the eight-month follow-up, suggesting that patients may require extended mental health support beyond the immediate recovery period. The study also revealed that higher alcohol consumption was associated with increased fear of recurrence and perceived stress, although average alcohol intake among participants was low. These findings have important implications for healthcare providers and heart attack survivors. As Zvonar explains, 'Health care often focuses solely on anxiety and depression, and treatment may include antidepressants, missing an important issue – patients may be experiencing fear of having another heart attack for another reason.' This suggests that fear of recurrence should be evaluated and addressed separately from depression and anxiety in post-heart attack care.
The study's results are particularly noteworthy given that the average age of participants was younger than 40, significantly below the typical age for first heart attacks in the United States. This raises questions about whether younger survivors may face unique psychological challenges in their recovery. While the study has limitations, including its reliance on self-reported data and potential selection bias due to recruitment methods, it highlights a critical area for further research and clinical attention. Glenn N. Levine, M.D., chair of the 2021 American Heart Association scientific statement on psychological health and heart disease, emphasized the importance of considering both the physical and psychological aspects of recovery: 'This study suggests that we should consider not only psychological factors, such as depression and stress after a heart attack, but additionally recognize that many people may have a genuine fear of experiencing another heart attack, which can also have a negative impact on their psychological health.'
The findings underscore the need for a more comprehensive approach to post-heart attack care that addresses not only physical recovery and traditional mental health concerns but also the specific fear of recurrence. As poor psychological health is linked to increased risk of future heart problems, addressing this fear could play a crucial role in long-term recovery and prevention. Healthcare providers may need to develop new strategies to assess and manage fear of recurrence in heart attack survivors, potentially incorporating extended follow-up care and targeted mental health interventions. This approach could help improve overall outcomes and quality of life for survivors, addressing a significant source of ongoing stress that has been previously underrecognized in post-heart attack care.
