After a Heart Attack, Better Mental Health Care May Save Lives

Close up of man wearing gray tee shirt clutching his chest like he's having chest pain


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Key Takeaways

  • Researchers have found that people with hostile personality traits who have had a heart attack are more likely to die if they have a second heart attack.
  • Hostile behaviors include being sarcastic, cynical, resentful, impatient, or irritable.
  • Experts recommend that the mental health needs of all heart attack patients are addressed as part of their follow-up care.

Researchers have found that heart attack patients who exhibit certain personality traits, including sarcasm, pessimism, resentfulness, impatience, and irritability, are at a higher risk for dying from a second heart attack.

To conduct their study, which was published on September 14 in the European Journal of Cardiovascular Nursing, the researchers followed 2,321 heart attack patients for the first 24 months following their cardiac event. They assessed patient disposition using he Multiple Adjective Affect Checklist (MAACL).

Of all the subjects included, 57% were deemed "hostile," according to the MAACL.

After controlling for sex, age, education, marital status, diabetes, high blood pressure, and smoking, the researchers concluded that while hostility did not increase the risk of a second heart attack, it did predict higher death rates for patients who did.

"A heart attack is not just a one-time event," Jagdish Khubchandani, PhD, a professor of public health at New Mexico State University, tells Verywell. "Any chronic disease requires ongoing management. No matter how well you treat the initial issue, you must also include care for the patient's emotional needs."

How a Hospital Stay Can Impact Mental Health

For individuals who have been hospitalized, many factors contribute to a decline in their mental and emotional health, Khubchandani says. For example, patients can experience trauma, a lost sense of well-being, and severe sleep deprivation, which impairs cognition.

The phenomenon is not unique to heart attack patients. It's also seen in patients with other conditions, such as stroke.

Additional Risk Factors for Decline in Mental Wellness

Heart attack survivors who are depressed or anxious are less likely to eat properly or exercise, Khubchandani says. They often do not have strong support systems in place, and are more likely to turn to alcohol or drugs to cope with negative feelings.

"There is a lack of a comprehensive approach to cardiac health," Khubchandani says, suggesting mental health screening should be a part of treatment. "We have the ability to diagnose mental illness within minutes using simple tools."

Returning to Previous Activities After a Heart Attack

Patients who must return to a stressful work environment after a heart attack particularly need emotional support. "They are acclimating themselves back to a normal life," says Khubchandani, who co-authored a 2014 study published in the Journal of Community Health that showed how workplace harassment can have a detrimental impact on health outcomes, especially cardiovascular outcomes.

"Employers have a big responsibility in making sure these people have enough help," Khubchandani says. "Many offer counseling services and employee assistance programs. The idea is to be able to screen and find those people who are at risk for health issues."

Khubchandani says that "yoga, better communication techniques, early screening for mental health issues, and designing a course of therapy tailored to the patient," are all strategies that can help patients in the aftermath of a medical crisis.

What This Means For You

Mental health care is important for everyone but could be even more important if you've had a heart attack.

If you do not already have a mental health provider, ask your cardiologist or primary care provider for a referral. If you are enrolled in cardiac rehabilitation, you could speak with the nurses, exercise physiologists, or other professionals who are monitoring your progress.

There are effective treatments for depression, anxiety, and stress. These measures can greatly improve your quality—and length—of your life.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Vitori TK, Frazier SK, Biddle MJ, Mudd-Martin G, Pelter MM, Dracup K, et al. Hostility predicts mortality but not recurrent acute coronary syndromeEuropean Journal of Cardiovascular Nursing. 2020:147451512095091. doi:10.1177/1474515120950913

  2. Khubchandani J, Price JH. Workplace harassment and morbidity among US adults: Results from the National Health Interview Survey. J Commmunity Health. 2015;40(3):555-63. doi:10.1007/s10900-014-9971-2

By Cyra-Lea Drummond, BSN, RN
 Cyra-Lea, BSN, RN, is a writer and nurse specializing in heart health and cardiac care.