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14 December 2012

Cardiac arrest psychologically hard

A quarter of cardiac arrest survivors suffer long-term psychological problems such as anxiety, post-traumatic stress disorder and depression, a new meta-analysis estimates.

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A quarter of cardiac arrest survivors suffer long-term psychological problems such as anxiety, post-traumatic stress disorder and depression, a new meta-analysis estimates.

This additional stress on recovering patients is under-diagnosed, researchers say, and there are few standard methods for identifying who is at risk.

"Anxiety, depression and PTSD are major concerns after cardiac arrest," said lead author Dr Kathryn Wilder Schaaf of Virginia Commonwealth University. "We have the tools to treat this, (so) it's important to make sure that it's identified," she added.

Many long-term care issues for survivors are unknown, experts said, largely because only 10% of the 382 800 Americans who suffer cardiac arrest each year survive.

How the study was done

Dr Wilder Schaaf and colleagues reviewed 11 studies published between 1993 and 2011 that looked at mental health issues following cardiac arrests experienced outside of a hospital and found problems plaguing anywhere from 15% to 50% or more of patients.

Months to years after surviving cardiac arrest, about one-third of patients were depressed and nearly two-thirds were experiencing anxiety. Even PTSD symptoms were surprisingly common, afflicting 19% to 27% of survivors.

In reality, however, the long-term mental health state of many cardiac arrest survivors is not typically considered or assessed, the researchers wrote online in Resuscitation.

But treating mental illnesses in other types of heart patients has been shown to increase long-term survival while decreasing costs, according to independent research.

What the study found

In a study published in November, for example, researchers found that a depressed patient recovering from a heart attack treated with psychotherapy and antidepressants during a six-month trial incurred - on average - $1 857 in medical costs, whereas a depressed patient who received no psychological treatments cost an average of $2 797 over the same time period.

Other research suggests that mental health issues impact physical recovery, too. Over a five-year period, survivors of cardiac arrest and similar events who did not show signs of PTSD lived three and a half times longer than those with ongoing trauma, according to a 2008 study by Dr  Karl-Heinz Ladwig at the Helmholtz Zentrum München in Germany.

Stress can affect the nervous system and impact heart rates, as well as worsening chronic inflammation, which also hurts the heart, Dr Ladwig said.

"We have problems convincing cardiologists to understand that depression is a very relevant part of their clinical work," Dr Ladwig said.

He suggested that doctors can gauge trauma through screening questions that are "easy to put in a normal discussion."

"This is a brand new area that is going to require thoughtful scientists, vigilant family members and an awareness from patients," said Dr Karina Davidson, director of the Center for Behavioral Cardiovascular Health at Columbia University Medical Center in New York, who was not involved in the new study.

Nightmares plus an avoidance of doctors, medications or follow-up appointments are all signs that a recovering heart patient should seek mental health help, Dr Davidson said.

(Reuters Health, December 2012)

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