What a doctor needs to check after cardiac arrest, according to new research

The care that comes after a cardiac arrest should include supporting mental health — especially for women, new research has found.

In the five years that followed an out-of-hospital cardiac arrest, or OHCA, in which the heart suddenly stops beating, women were more likely than men to receive medication to treat anxiety or depression, according to a report published Monday in the journal Circulation: Cardiovascular Quality and Outcomes.

“We recommend monitoring of social and mental well being in individuals who survived an OHCA, not just directly after the event but also in the long-term,” said the study’s first author, Dr. Robin Smits, in an email.

“This seems particularly relevant in women but will likely also benefit men.”

Researchers analyzed data from 259 women and 996 men in the Netherlands who survived at least 30 days after a cardiac arrest that took place outside a hospital between 2009 and 2015. The team compared the data on patients’ socioeconomic status and mental health with those in the general population, according to the study.

The amount of women taking anxiety or depression medications after cardiac arrest was also greater than in women in the general population, said Smits, a postdoctoral researcher at Amsterdam University Medical Center in the Netherlands.

“Further investigation may shed light into which interventions are necessary for physicians to be able to help individuals thrive after OHCA,” Smits said.

Researchers have been learning more and more about how closely connected mental and cardiac health are, said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver. He was not involved in the research.

One in five people hospitalized for heart attack (a blockage of blood flow to the heart) or chest pain develop major depression — about four times the rate in the general population, according to the American Heart Association. One in three stroke survivors become depressed, along with up to half of those who undergo heart bypass surgery, past studies found.

“Mental health and stress make cardiac events worse and more frequent, and we know that cardiac events make mental health worse,” he said.

Just the start delving into mental and cardiac health

This new study investigates an important topic but it’s just the beginning, Freeman said.

While the authors did account for factors that might skew the results, there are a lot of them, he said.

For example, the research was only able to look at the number of people prescribed medication — but that doesn’t necessarily mean they were the only people experiencing anxiety or depression, Smits said.

“The results may also in part reflect that men may less often seek care for mental health and are perhaps less frequently assessed and prescribed medication,” she said in an email. “Moreover, the data do not fully reflect lived experience, such as forced changes in job responsibilities or effect in other areas of life.”

But this study highlights an important concept: that men and women often experience the world differently, and providers need to be conscious of that to give everyone their best care,  Freeman said.

Checking in on emotional well-being

The biggest lesson of this latest research is for loved ones and health care providers to check in on people who have experienced cardiac arrest, Freeman said.

“Is there a strategy that we should be taking that’s more proactive after people have a cardiac arrest, to sort of make sure that they’re back on their feet, that they understand that they are amazing survivors in many cases?” he said.

Even if the doctor you are following up with isn’t a psychiatrist, it is important to keep an open line of communication about your well-being — and then you may be referred to a mental health professional, he said.

Fortunately, there are a lot of strategies to improve mental health. Past studies have shown cognitive behavioural therapy, regular exercise and proper sleep to be effective tools for managing emotional welfare.

“As a physician, how do we help people avoid or treat these problems as they arise? Or even before they arise?” Freeman said.