Research indicates that stress following a heart attack is a common experience, with new studies revealing that fears surrounding the possibility of another heart attack may significantly contribute to this stress. Dr. Sarah Zvonar, a cardiac critical care nurse and postdoctoral researcher at the Indiana University School of Nursing, emphasizes the importance of understanding these fears. This knowledge could enhance care for patients who have survived a heart attack. She shared her preliminary findings at the recent American Heart Association’s Scientific Sessions in Chicago, with further publication pending in a peer-reviewed journal.
While the fear of recurrence has been extensively studied in the context of cancer, Zvonar highlights that it has been largely overlooked in cardiology. Her personal experiences, including watching the struggles of her father and friends’ fathers after heart attacks, inspired her research. These men frequently voiced concerns about potential future heart issues, asking, “Is this going to happen again?”
To investigate these emotions, Zvonar and her research team engaged 171 individuals who had survived at least one heart attack between November 2021 and December 2022. The participants underwent surveys designed to measure stress, anxiety, depression, fear of recurrence, and their perception of their health status. On average, six months had elapsed since their heart attacks. Follow-up surveys were conducted about six weeks later.
Zvonar’s analysis focused on identifying predictors of fear of recurrence and perceived stress. She noted distinct factors for each: younger and white participants were more likely to fear recurrence compared to older or Black participants. The perception of their health, including concerns about the duration of their issues and aspects of their health they could control, predicted fear of recurrence. On the other hand, perceived stress correlated with alcohol consumption and levels of fear over potential recurrence.
When adjusting for anxiety and depression in her analysis, the fear of recurrence emerged as a key independent contributor to stress. Zvonar observed that higher levels of fear related to recurrence connected to increased stress levels, which can potentially lead to future heart complications, including another heart attack.
Understanding the nuances between fear of recurrence, stress, anxiety, and depression is crucial for improving patient care. While anxiety and depression are chronic mental health conditions that can be managed with medication, fear and stress require different intervention approaches. This fear can arise unexpectedly, triggered by sensations like pain during everyday activities, leading individuals to question if they are experiencing another heart event. It can also result in anxiety about medical appointments due to the fear of negative outcomes.
Dr. Kim L. Feingold, a cardiac psychologist from Northwestern Medicine, expressed that the study’s findings align with the understanding that fear affects the body’s stress response. While temporary fear and anxiety can serve protective purposes, excessive or chronic fear can adversely influence mood and health. She noted that following a heart attack, many individuals experience diminished confidence in their own bodies and struggle to differentiate between benign and concerning symptoms.
Feingold compared managing these emotions to driving again after a car accident. The initial anxiety can subside over time, but early intervention from healthcare providers can be beneficial. It’s essential that patients have guidance in interpreting their symptoms, particularly in the few months following a heart attack. This support can significantly aid their recovery and help them regain confidence.
Zvonar acknowledged certain limitations in the study. A majority of participants, 69%, were women, and the average age was 39, significantly younger than the typical age for first heart attacks in the U.S. Moreover, the relatively short interval between surveys may not fully capture the evolution of fear of recurrence, as levels remained consistent.
Looking ahead, Zvonar hopes future research will explore strategies for helping survivors manage their fears. She believes the medical community should develop effective ways to assist survivors and their families through both physical and psychological challenges following a heart attack. Zvonar emphasized the need for improved communication regarding what it means to navigate recovery, aiming to enhance not just longevity but also the overall quality of life for heart attack survivors.