Aims: Negative mood states (e.g., anxiety and depression) have been associated with increased cardiovascular morbidity and mortality in coronary artery disease (CAD), but little is known about the impact of positive emotions on these health outcomes. We examined whether anhedonia (i.e., reduced positive affect) was associated with 7-year mortality in patients treated with percutaneous coronary intervention (PCI).
Methods: Consecutive PCI patients (n = 1206; 71.5% men; mean age 62.0 ± 11.1 years) from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry completed the Hospital Anxiety and Depression Scale (HADS) to assess anhedonia at baseline. Anhedonia was defined as a score ≤ 7 (i.e., one SD below the mean) on the positive affect scale of the HADS. The endpoint was defined as all-cause mortality.
Results: The prevalence of anhedonia was 23.7% (286/1206). After a median follow up of 7.0 ± 1.6 years, 186 deaths (15.4%) from any cause were recorded. The incidence of mortality in anhedonic patients was 22.7% (65/286) vs. 13.2% (121/920) in non-anhedonic patients (HR = 1.66, 95% CI [1.19-2.32], p = 0.003). Cumulative hazard functions were significantly different for anhedonic vs. non-anhedonic patients (log-rank χ(2) = 16.61, p < 0.001). In multivariable analysis, anhedonia remained independently associated with all-cause mortality (HR = 1.51, 95% CI [1.03-2.22], p = 0.036), after adjusting for socio-demographics, clinical characteristics, and negative and relaxed affect.
Conclusion: Anhedonia was independently associated with a 1.5-fold increased risk for all-cause mortality in patients who survived the first 6 months post-PCI. Enhancing positive emotions, in addition to reducing negative emotions, may constitute an important target for future psychological intervention trials in CAD patients.