Top Things to Know: Post-Myocardial Infarction Psychological Distress: A Scientific Statement
Published: September 22, 2025
- Psychological distress in patients with cardiovascular disease is increasingly recognized as both a contributing factor to the development and progression of cardiovascular disease and a consequence of the development of cardiovascular disease.
- Patients with acute myocardial infarction (MI) are at increased risk for depression, anxiety, psychosocial stress, or post-traumatic stress disorder (PTSD).
- These negative psychological factors when occurring post-MI have been referred to as post-myocardial psychological distress (PMPD).
- There are several plausible mechanisms that have been proposed by which MI may induce (PMPD) including pro-inflammatory cytokines initiated from the MI event which in turn influence the brain including the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS).
- Other possible mechanisms by which MI may lead to PMPD also include avoidance, fear, withdrawal, and financial strain.
- Up to half of patients post-MI may experience some form of psychological distress. Roughly 1 in 3 patients who experience an MI will go on to develop symptoms of depression.
- PMPD is associated with increased risk of recurrent adverse cardiac events, and depression post-MI can reasonably be formally characterized as a cardiac risk factor, along the lines of more traditional cardiac risk factors such as hypertension and diabetes.
- Mechanisms by which PMPD may in turn lead to increased future cardiac risk include reduced physical activity, smoking (and failure to stop smoking), excess alcohol consumption, poor diet, obesity, inadequate sleep, inadequate social support, decreased medication adherence, and poor attendance at cardiac rehabilitation.
- Risk factors for post-MI psychological distress include younger age, female gender, racial/ethnic groups status, lower educational level, living alone, perceived absence of social support, being unmarried and unemployed, history of a psychiatric disorder, having an unhealthy lifestyle, immigration status, and a history of cardiovascular, metabolic, and respiratory complications.
- It is unclear whether post-MI patients should be screened for PMPD, but at a minimum health care professionals should be aware of the incidence of PMPD and be aware of signs of depression, anxiety, psychological stress, and PTSD in their patients in the immediate in-hospital setting and during follow-up visits in the clinic.
Citation
Levine GN, Carney RM, Cohen BE, Dunn SL, Gaffey AE, Kronish IM, Olsson EMG, Huffman J; on behalf of the American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Quality of Care and Outcomes Research; and Council on Lifelong Congenital Heart Disease and Heart Health in the Young. Post–myocardial infarction psychological distress: a scientific statement from the American Heart Association. Circulation. Published online September 22, 2025. doi: 10.1161/CIR.0000000000001381