Long-Term Anxiety After Cardiac Arrest Affects More Women Than Men
A recent study highlights the need for cardiac arrest survivors to identify and treat mental health issues.
Women have a much greater risk of experiencing anxiety months after cardiac arrest than men, according to findings presented at a scientific gathering of the European Society of Cardiology (ESC) on Sunday.
The study, which tracked 245 patients who had a cardiac arrest and then were admitted to the hospital in a coma, found that 43 percent of the women reported a level of anxiety considered borderline or higher four months after their heart suddenly stopped, compared with 23 percent of men.
“Cardiac arrest occurs with little or no warning, and it’s common to feel anxious and low afterwards,” said Jesper Kjaergaard, MD, PhD, an author of the study and a faculty member at the department of cardiology at the Rigshospitalet Copenhagen University Hospital in Denmark, in a press release. “Our study indicates that women are more affected psychologically and could be targeted for extra support.”
Women Are More Likely to Report High Anxiety and Possible PTSD After Cardiac Arrest
Measures of anxiety and depression were determined on the basis of responses to a self-evaluation in which patients rated statements related to psychological distress; for example, “I get sudden feelings of panic.”
With anxiety and depression each rated on a scale of 0 to 21, the average depression score for women was 3.3, versus 2.6 for men. The average anxiety score was 6.1 for women and 4.5 for men. Scores between 8 and 10 indicated borderline anxiety or depression, while 11 or higher indicated anxiety or depression.
Dr. Kjaergaard and his colleagues noted that 23 percent of the women had borderline anxiety, compared with 11 percent of the men. One in five women had levels of anxiety above borderline, whereas just over 1 in 10 men did. Authors did not find significant differences in depression.
From a separate evaluation for PTSD (post-traumatic stress disorder), researchers observed that women had significantly higher scores — a median of 33, versus 26 for men. Under this rating system, scores of 31 to 33 suggested probable PTSD.
Coping With a Sudden Major Health Issue
Cardiac arrest is a life-threatening health event. As the American Heart Association describes it, when someone goes into cardiac arrest, heart function suddenly ceases. If blood flow is not restored quickly, the individual can pass out and die within 10 to 20 minutes. Every year, about 365,000 people have these events outside of a hospital setting, and of those, only about 10 percent survive, according to the Sudden Cardiac Arrest Foundation.
According to Jayne Morgan, MD, a cardiologist at Piedmont Healthcare in Atlanta, psychological distress is common for anyone who has had this type of major health trauma. “Not only do we see this in cardiac arrest, but also after serious surgeries, prolonged hospitalizations for any cause, and unexpected medical complications delaying recovery expectations,” she says.
As to why women are more prone to these feelings, Dr. Morgan suggests that women often shoulder greater family responsibility, and as caregivers, they can see a cardiac arrest and the road to recovery as placing a burden on family members.
Previous research found that women are more likely to “ruminate” than men. “This involves repetitive cycles of worrying and negative thoughts, which increase the risk of depression and anxiety,” says Anais Hausvater, MD, a cardiologist at NYU Langone Health in New York City.
Spotting the Signs of Psychological Distress
Anxiety and depression often go hand in hand. Recognizing the symptoms can help a person get the treatment they need. The Centers for Disease Control and Prevention (CDC) provides an extensive list of depression signs, including:
- Feeling sad all the time
- A sense of hopelessness
- Eating more or less than usual
- Sleep trouble
- Lack of interest in activities, family, and friends
Anxiety may make an individual feel fear, worry, or panic.
Sometimes psychological issues can manifest as symptoms similar to those of a heart condition, such as chest pain, trouble breathing, and palpitations. “If you are having symptoms that may be related to your heart, or if you aren't sure, it is always best to consult with your doctor,” says Dr. Hausvater.
A number of concerns tied to recent cardiac arrest can stoke feelings of anxiety. Patients may feel especially vulnerable, with fears about loss of independence, financial concerns, and physical limitations.
Knowing more about what is to come may alleviate some anxiety. Many patients will improve as their physical symptoms decrease, and it also helps to have the support of family and friends. Setting expectations, and having a full understanding of recovery and rehabilitation timelines can also decrease anxiety, according to Morgan.
While mindfulness, meditation, regular exercise, and healthy diet can be extremely helpful for various mood conditions, some patients may require psychotherapy or medications, or both.
Hausvater, who was not involved in the recent study, says more extensive research is needed on the subject. She stresses that the total population for this study was relatively small, and only 18 percent were women.
“The findings confirm our experience in clinical practice, that the psychological effects of cardiac arrest persist for months,” said Kjaergaard in the press release. “Future studies are needed to investigate whether talking to a professional can help alleviate psychological symptoms.”