Depression tied to recurrent chest pain
Depression seems to be a significant independent predictor of recurrent chest pain (RCP) in patients with acute chest pain, regardless of cardiac ischaemia, a recent study has shown.
“Our findings support prior reports that depression, anxiety and stress are prevalent in the chest pain population, but further establish that depression alone is associated with RCP, which leads to recidivism,” said researchers.
Investigators divided 365 low-to-moderate risk emergency department patients into two: those with RCP (n=131; mean age 51±8.6 years; 60.3 percent female) and those without (NRCP; n=234; mean age 55±12.0 years; 53.9 percent female).
Over the median follow-up period of 36 days, mean depression, anxiety and perceived stress scores were higher in the RCP group (6.78±5.8, 46.3±16 and 17.4±9.2, respectively) than in the NRCP group (4.61±4.3, 41.3±12.2 and 16.1±7.8, respectively). RCP prevalence was 36 percent in those that completed the follow-up. [Am Heart J 2017;191:47-54]
Multivariable regression models, after adjusting for potential confounders, showed that only depression was independently associated with higher risks of 30-day RCP (odds ratio [OR], 2.11; 95 percent CI, 1.18 to 3.79).
In contrast, perceived stress (OR, 0.96; 0.67 to 1.66) or clinical anxiety (OR, 1.59; 0.80 to 3.20) was not significantly linked to higher odds of 30-day RCP. When taken together, perceived stress and anxiety were also not associated with the risk of RCP (n=272; OR, 1.12; 0.70 to 1.78; p=0.64).
Only when analysed with depression did perceived stress (n=85; OR, 2.00; 1.09 to 3.68; p=0.03 for trend), anxiety (n=91; OR, 2.00; 1.11 to 3.62; p=0.02 for trend), and both anxiety and perceived stress (n=85; OR, 2.00; 1.09 to 3.68; p=0.03 for trend) correlated significantly with the risk of RCP.
At baseline, use of antidepressants was significantly associated with RCP (OR, 2.82; 1.43 to 5.52) while anxiolytic use was not (OR, 1.47; 0.79 to 2.73). Patients on antidepressants and anxiolytics had higher risks of RCP (OR, 3.88; 1.14 to 13.2).
The current study highlights important findings, chief of which is that patients with chest pain admitted to the emergency department also suffer from high rates of psychological morbidities including depression and anxiety.
Of these morbidities, depression significantly correlated with RCP, potentially through the mediation of lifestyle, according to researchers.
“Depression has been implicated in chest pain symptomatology through a variety of pathways. It tends to be associated with less healthy lifestyles and comorbidities that could increase risk of chest pain recurrence,” they said.
Interestingly, while anxiety and perceived stress were more prevalent in the patients with chest pain, depression was still the psychological condition that showed the strongest statistical link.
“Depression appears to be independently associated with RCP, among other psychological conditions associated with incident [coronary artery disease]. Approaches to screen and manage depression early in the ED chest pain centre may have significant implications in curtailing recidivism and improve quality of life for these patients,” said researchers.