Anhedonia as predictor of clinical events after acute coronary syndromes: a 3-year prospective study.

BACKGROUND

Depression after acute coronary syndromes (ACS) is an important risk factor for further coronary events; but the influence of anhedonia, the decreased capacity to experience pleasure, has received little attention. The aim of the study was to investigate the effects of anhedonia on prognosis at 3-year follow-up in patients hospitalized for ACS.

METHOD

Consecutively admitted ACS patients (n = 291) completed the Chapman Physical Anhedonia Scale (PAS) and the Hospital Anxiety and Depression Scale depression subscale (HAD-D) at baseline (1-4 days after their admission). Two definitions of anhedonia were taken into account: dimensional definition using PAS score as well as categorical definition using several cutoff scores (hedonics: PAS less than 23 or 29; anhedonics: PAS equal to or greater than 23 or 29). Patients were followed during 3 years for adverse clinical events divided into severe cardiac events (mortality or myocardial infarction [MI]) and clinical events (mortality, MI, recurrence of ACS, hospital readmission, and onset or deterioration of heart failure).

RESULTS

At follow-up, there were 176 clinical events (36 deaths, 8 MIs, 58 ACS, 55 hospital readmissions, 19 heart failures). Dimensional anhedonia and depression were associated with poor prognosis, but anhedonia was the only predictor of severe cardiac events and clinical events after adjusting for demographic and clinical variables. Contrary to depression, categorical anhedonia (PAS >23) was an independent and significant predictor of severe cardiac events after adjusting for clinical variables. The incidence of death/MI in hedonics vs anhedonics was 11.1% vs 22.1% (hazard ratio = 2.18; 95% confidence interval, 1.11-4.26).

CONCLUSIONS

Dimensional and categorical anhedonias predicted independently severe cardiac events and clinical events after ACS.