Patients with acute coronary syndrome at increased risk of suicide

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Patients with acute coronary syndrome may be at an increased risk for suicide compared to otherwise healthy people, according to new research in the Journal of the American Heart Association.

“Depression and anxiety that develop after an acute coronary syndrome (ACS) diagnosis have been associated with limited physical abilities, reduced physical function, poor health-related quality of life and an increased risk of new cardiovascular events or death,” says Jung-Chen Chang co-senior author and assistant professor at the School of Nursing in the College of Medicine at National Taiwan University, Taipei City, Taiwan. “In our study, we found the odds of suicide to be high among patients with ACS.”

The researchers used the National Mortality Registry in Taiwan to identify 41,050 people aged 35 years or older who committed suicide between 2000 and 2012, and then compared them to 164,200 people with similar demographics. After adjusting the data for diabetes, stroke, chronic kidney disease and psychiatric illness from the Health and Welfare Data Science Center in Taiwan, the researchers found that during the first six months after an ACS diagnosis, people with ACS were 200% more likely to commit suicide than people in the comparison group. After adjustment for other risk factors, such as mental illness, the rate of suicide declined among ACS patients to around a 15% higher risk, which is still considered significant.

Although the study used patient data from Taiwan, the authors said the findings are applicable to other countries, including the USA, since acute heart attack is one of the leading causes of death in most countries where the high prevalence of ACS represents a significant burden on healthcare resources.

Coronary heart disease and depression are two of the most critical causes of disability in countries with advanced economies. Numerous meta-analyses, prospective studies and systematic reviews have shown that depression is common in patients with ACS, but according to Chang, these studies have not reported the association between ACS and suicide after adjusting for diabetes, stroke, chronic kidney disease and psychiatric illness.

In 2008, a science advisory issued by the AHA recommended routine screening for depression in all patients with ACS, but the implementation of this recommendation remains insufficient in clinical settings, the authors said.

“We recommend that healthcare providers take the increased odds of suicide into their evaluation of patients newly diagnosed with ACS,” Chang says. “In addition to the existing efforts for managing depressive symptoms and reducing suicide, all cardiologists should be aware of the potential associations between ACS and suicide and make necessary referrals to specialists for suicide prevention.”