Antidepressants and other psychotropic drugs are associated with an almost doubled risk of premature death in patients with heart conditions.
Psychotropic drugs treat mental health disorders. They work by adjusting the number of major chemicals in the brain, called neurotransmitters. Increasing or decreasing certain neurotransmitters counters the effects of certain mental illnesses.
The new research was published in the European Journal of Cardiovascular Nursing, a journal of the European Society of Cardiology (ESC).
Exploring psychotropic drugs and cardiac disease
Previous studies found an association between anxiety symptoms and poor health outcomes, including death, in patients with cardiac disease. This study explored the impact of psychotropic medication on those with heart conditions and focused on establishing if there was a link between mental health medication and death.
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 before 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 discovered that 2,335 participants (18%) redeemed at least one prescription of psychotropic drugs. The most commonly used drugs were benzodiazepines (68%) and antidepressants (55%). It was also revealed that the use of psychotropic drugs was higher amongst certain groups, including:
- women,
- older patients,
- smokers,
- widowers,
- those with less education,
- patients with greater numbers of co-existing health problems.
In the study, 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%).
“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,” said study author Dr Pernille Fevejle Cromhout of Copenhagen University Hospital, Denmark.
Risk of death and mental health in cardiac patients
A total of 362 patients (3%) died within the first year after discharge from the 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 before 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 1.81 higher odds of all-cause death during the same period.
Furthermore, the associations became weaker when they were adjusted for the use of psychotropic medication before hospitalisation and the presence of anxiety. The 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.”
