A recent scientific statement from the American Heart Association (AHA) has highlighted the importance of recognizing and treating psychological distress—such as depression, anxiety, and post-traumatic stress disorder (PTSD)—among heart attack survivors.
According to the AHA report, 33% to 50% of heart attack survivors experience psychological distress. These rates are substantially higher than in the general population and have been linked to a heightened risk of recurrent cardiac events and diminished quality of life. Despite this, psychological distress often remains undetected and untreated in cardiac recovery settings.
Dr. Ankur Agarwal, Associate Director of Interventional Cardiology at ApolloMedics Hospital, Lucknow, called the findings “a wake-up call.” He said, “We have long known in practice that the heart and mind are deeply connected. Patients burdened with psychological distress after a heart attack recover more slowly and face a higher chance of complications. This study quantifies that risk and reinforces the need to treat mental health as part of heart health.”
He added, “Families and patients tend to focus on the physical side such as angioplasty, medication and diet, while overlooking emotional struggles. Healthcare systems rarely have structured screening for depression or anxiety in cardiology wards. Unless someone asks the right questions, a patient may be silently suffering. Cultural stigma only adds to the silence.”
Dr. Agarwal suggests practical ways hospitals can respond. “We can start with routine screening questionnaires during follow-ups and embed psychologists or counselors in cardiac units. Multidisciplinary teams that include cardiologists, dietitians, physiotherapists and psychologists should jointly plan recovery. Nurses and staff must be trained to recognize psychological red flags with the same seriousness as chest pain.”
“Medication is only one aspect of recovery,” he noted. “We emphasize four pillars, physical activity, balanced diet, adequate sleep and stress management. Stress management often gets the least attention, but yoga, mindfulness or even a daily walk can lower stress hormones. Social support is one of the most underrated but powerful protectors.”
Highlighting the positive impact of psychological care, Dr. Agarwal said, “Patients who undergo counseling or join rehabilitation programs with a psychological component stick better to their medications, diets and exercise plans. I have seen patients who felt hopeless regain confidence & motivation and their cholesterol, blood pressure and fitness improve significantly. It is not just about preventing another heart attack, it is about restoring quality of life.”
Dr. Deepak Padmanabhan, Senior Consultant and Strategic Lead – Cardiac EP Collegium, Narayana Health, Bengaluru, also emphasized that psychological distress is a serious cardiovascular risk. “Psychological distress after a heart attack isn’t ‘soft’ science—it carries real risk. The latest AHA scientific statement finds persistent distress is common (about one-third to one-half of survivors) and is linked to more repeat events and deaths. Depression and PTSD can roughly double risk; anxiety raises risk too, though a bit less. The signal is consistent even if causation isn’t fully proved. Screening and treatment belong in heart care.”
He explained why psychological distress often goes unnoticed, saying, “We focus on arteries and ignore emotions. Time-pressed clinics rarely use brief screeners. Symptoms are ‘invisible,’ patients under-report due to stigma, and teams lack clear referral pathways. Cardiac metrics get measured; mood often doesn’t. Fragmented systems and limited mental-health access compound the gap. Besides that, a cardiac event is an encounter and reminder of one’s mortality; considering it by itself is a challenge; coming face to face with it in a cardiac event is definitely frightening and overwhelming; it is always present though not often acknowledged.”
Dr. Padmanabhan urged routine screening, recommending, “Make screening routine (PHQ-2/PHQ-9 for depression; GAD-2/7 for anxiety; brief PTSD checklists). Embed psychologists or trained counselors in cardiac rehab. Use stepped-care: brief CBT, problem-solving therapy, social-support coaching, and, when needed, medications. Create warm handoffs, offer virtual visits, involve family, and track mood alongside BP, LDL, and step counts.”
On lifestyle changes, he advised, “Enroll in cardiac rehab early. Walk daily; aim for 150 minutes/week. Eat a Mediterranean-style diet; limit salt and ultra-processed foods. Quit tobacco; keep alcohol modest. Sleep 7–8 hours. Practice brief, daily stress-reduction (breathwork, mindfulness, prayer). Build social connection and purpose. Make small, repeatable habits the default; ensure sarcopenic obesity (thin body; high fat content) is not there.”
He acknowledged that while mortality effects from psychological interventions are mixed, “Trials show collaborative care improves depression, quality of life, and treatment uptake; ENRICHD improved depression/support but not the primary survival endpoint. Importantly, when depression actually remits, risk seems lower—so effective, monitored care matters.”
Dr. Padmanabhan called for systemic change, “Mandate brief mental-health screening after MI. Pay for integrated ‘cardio-psych’ models and home/virtual cardiac rehab. Tie quality metrics to screening, referral, and mood improvement. Expand the workforce via collaborative-care training. Enforce mental-health parity so counseling is covered like statins. Use registries to track distress and outcomes across hospitals.” He concluded, “Healing the heart means treating the mind—systematically, compassionately, and as part of standard cardiac care.”
Dr. Sachin Baliga, Consultant Psychiatrist at Fortis Hospital, Bannerghatta Road, Bengaluru, explained, “The relationship between cardiovascular and mental health is strongly multidirectional. Cardiovascular well-being is affected by both biological and psychological risk factors. Biological risk factors include high cholesterol, hypertension, diabetes, and smoking. However, increasingly, the evidence suggests psychological risk factors, such as the effects of distress from depression, anxiety, or chronic stress, can also be significant cardiovascular risk factors. For example, stress hormones can increase blood pressure, alter plaque formation, and affect heart rhythms and place mental health at the forefront of cardiac care.”
He added, “Based on my clinical experiences, some patient populations are particularly vulnerable to post-myocardial psychological distress. For example, individuals with psychological proneness, such as those with past or family history of mental health issues, or in general not well-equipped to deal with the stresses of life due to various factors. A lot of times, this group includes the go-getters and workhorses, who for the first time in their life experience a brush with morbidity, that destabilizes them. Apart from that, older adults, especially retirees living at home alone, and patients with minimal social or family support often describe higher levels of anxiety and/or depression after a heart attack. Furthermore, these feelings of distress may not be transient. Faces of anxiety and/or depression may act as barriers to recovery and/or medication compliance, and they will often be detrimental to long-term survival.”
He emphasized, “Psychological distress is directly related to how recovery occurs after a cardiac event. Patients who remain anxious or depressed after a cardiac event tend to have more difficulty living a healthy lifestyle, starting exercise programs, and/or changing dietary habits. Patients may neglect medications, schedule follow-up visits, or isolate socially putting them at greater risk. They may simply be scared to get back to any level of physical activity, or decide to not get out of bed altogether. They get terrified of staying alone, travelling alone, fearing the worst. I am frequently struck by the patterns I observe in patients, such as inability to sleep, overeating or lack of appetite, poor participation in physical activity, or extenuating use of substance.”
He concluded, “Psychological distress is already recognized as a cardiovascular risk factor with equal merit to more traditional risk factors. To not take psychological distress into account means failure to consider an important indicator of patient outcomes. The European Society of Cardiology (ESC), during the launch of this year’s consensus statement on mental health and cardiovascular disease, announced: there’s no health without mental health. Institutes housing Preventive Cardiac clinics are now beginning to incorporate mental health services to make it a holistic approach towards healthcare delivery.”
“Targeted interventions based on individual need can be life-altering,” Dr. Baliga continued. “Cognitive Behavioural Therapy (CBT) and structured cardiac rehabilitation programs, which include counselling, mindfulness practices and stress management techniques, are demonstrably effective practices. In patients with moderate to severe depression or anxiety, the careful use of antidepressants prescribed by a psychiatrist have also been of value. I cannot emphasize enough how important the choice of medications is, particularly to ensure the individuals don’t get simply prescribed with sleep medications and get addicted to them in the process. Importantly, having family members understand and be involved in the recovery of loved ones provides emotional support and leads to increased adherence to treatment plans.”
“Ultimately,” he said, “the assessment and treatment of psychological distress is not optional; psychological distress speaks to the overall nature of patient’s cardiac care. A heart-healthy measure to live is incomplete without mental health, so as cardiologists we need to assess and provide some form of therapy for psychological distress throughout recovery.”
A holistic future for cardiac recovery
The American Heart Association strongly recommends integrating mental health screening and management into routine cardiac care, especially for vulnerable populations such as women, minorities, and those with prior mental health issues. Supporting heart attack survivors through emotional recovery, alongside physical rehabilitation, is essential for improving overall quality of life and reducing the risk of repeated cardiac events.
Psychological distress is no longer just a mental health issue; it is a cardiovascular risk factor that demands attention, intervention, and integration into standard cardiac care to ensure comprehensive healing.
