Canadian Journal of Cardiology



      Cardiovascular disease (CVD) is the leading global cause of mortality, with ischemic heart disease causing the most cardiovascular deaths. CVD is traditionally considered to be more prominent in men, however, it accounts for a slightly higher percentage of mortality in women. Within a year of an acute myocardial infarction (AMI), women have a higher mortality rate than men, which is sustained at the five-year mark. Several studies have demonstrated that women are significantly more likely to experience depression and anxiety following AMI and may be in part contributing to the observed higher rates of morbidity, mortality, and re-hospitalization. There is a clinical gap as to how mental health screening and support should be approached in women following AMI. The objective of the present study was to investigate the association between anxiety, depression, and sex while identifying the influence of psychosocial factors.


      A total of 118 participants (83 male; 34 female) with AMI diagnosis were prospectively recruited from Kingston General Hospital within 72 hours of admission for AMI. Participants received a demographic questionnaire consisting of age, sex, socioeconomic status, marital status, race, history of smoking, history of drug/alcohol use, living situation, cardiac risk factors, and attitudes toward COVID-19. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) with Anxiety (HADS-A) or Depression (HADS-D) subscale score >7 indicating significant depression or anxiety, respectively. Anxious participants (HADS-A>7) were more likely to be female (OR 7.01; p=0.0001), unemployed (OR 6.72; p= 0.0061), report increased loneliness during COVID-19 (OR 3.74; p=0.0054), and report a household income of less than $20,000 CAD (OR 5.31; p=0.0110) while depressed participants were more likely to be female (OR 3.21; p=0.0313). Within the group of female participants, those who were unemployed were more likely to be depressed (OR 15.00; p=0.0309).


      The present pilot study demonstrated the impact of CVD risk factors and sociodemographic variables on post-AMI depression and anxiety, with a focus on sex differences. Participants who were female, unemployed, lonely during COVID-19, and who had a household < $20,000 were at high risk for anxiety. Female participants were at higher risk for depression, particularly if they were unemployed. The emerging trends in this pilot study highlight the need for continued data collection. This will inform interventions following AMI in the primary care and cardiac rehabilitation settings as well as prevention strategies at the public health level in order to reduce associated morbidity and mortality.
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