One in five patients reported feeling extreme distress and fear of dying, while two-thirds experienced more moderate emotional reactions. People who were younger, poorer and unmarried (possibly indicating social isolation) were more likely to have intense reactions, the study found.
Fear of dying was associated with a fourfold increase in TNF levels at time of admission to the hospital. Three weeks later, TNF levels were found to be linked with lower heart rate variability and lower cortisol levels.
Lower heart rate variability levels have been linked with higher death rates after a heart attack, while lower cortisol levels may indicate that the body isn't able to quell the inflammation caused by a heart attack.
To the researchers' surprise, having had a previous heart attack didn't influence how scared the patients were.
The study does have some limitations, including the fact that some 23 percent of the patients dropped out after three weeks; there were few women; and most patients had STEMI (ST-elevation myocardial infarction), the more severe type of heart attack, meaning that the findings can't really be extrapolated to non-STEMI heart attacks.
"It's a very small study, it's predominantly those with STEMI heart attacks and, most of the patients, we don't know all the clinical information," said Dr. Stephen Green, associate chairman of cardiology at North Shore University Hospital in Manhasset, N.Y.
Nor does the study answer the "chicken-and-egg" question of whether emotional distress caused the biological findings or vice versa.
"The study provokes a lot of thoughts in terms of what physicians should do with patients and what patients should do for themselves and [directions for] future research. [But] it's just a beginning in my mind and something that we shouldn't translate into changing our practices at this point," Green said.
The American Heart Association has mo
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