Coping with a heart event: your questions answered

Professor Andrew Steptoe

Professor Andrew Steptoe, BHF Professor of Psychology, answers common questions about how having a heart attack or other heart event can affect people emotionally.

Why is the psychological impact of a heart event important?

There’s no doubt having a heart attack or an admission for a cardiac event can be very stressful, and so we need to understand how people go through that process and how we can best support them.

Also, it has become clear over the last 20 years or so that some people have quite severe psychological reactions. In particular, you tend to get quite high levels of depressive symptoms and what’s been found is that those who get depressive symptoms are actually more likely to have recurrent cardiac problems. There is thought to be around a twofold risk [in those people] of having another heart attack or dying of heart disease, and there’s a lot of concern at the moment as to how that link takes place and what we can do about it.

Are there differences in how people cope?

People who get depressive symptoms are actually more likely to have recurrent cardiac problems

Some people find this very stressful in an acute sense; a number of people will feel that they might be dying and will feel very anxious about their future health. After that initial stage people can sit back a little bit but what then happens is that people have to think about their lives rather differently from the way they did before.

Many people, particularly young people who’ve had a heart attack, may not have known that they were at risk, so will find themselves suddenly confronted with the idea of their own risk. This requires quite a lot of psychological adjustment.

What the large-scale studies show both in this country and in other countries is that 15 per cent or so of people who have survived a heart attack become quite seriously depressed in the first few weeks following that. For some of those, that depression will be quite persistent.

Another 25 per cent or so experience milder levels of depressive symptoms, or anxiety symptoms; in total it’s about four in ten patients do experience quite severe emotional responses, which as I said earlier have been linked with future problems as far as their cardiovascular health is concerned, so it’s quite a sizeable problem.

What about people diagnosed with high cholesterol or high blood pressure?

People will find themselves suddenly confronted with the idea of their own risk

These are very different situations from having a heart attack, and people who have been diagnosed with high blood pressure or high cholesterol really shouldn’t become anxious or depressed. If they are it’s probably because they’re not being well-informed by their physicians about the nature of these risks.

Do people also feel positive, lucky to be alive?

That’s all part and parcel of the whole experience. What we’ve come increasingly to realise is that people who have survived a serious illness sometimes see a sort of benefit in a curious way, because it focuses their minds on the important things in their lives. People think ‘This is my only life and I really have to get on with it and I am going to prioritise the things that I really want to do with my family and others’. They find, to some extent, a silver lining in some of these very negative experiences. Some do see this as a wake-up call.

What about the psychological impact on partners and friends?

Some people have an avoidant way of coping, in that they don’t really want to think about the problem, they think it’s better to shut it out of their minds and just carry on with what they were doing before and not really think about it.

Some people don’t really want to think about the problem, they think it’s better to shut it out of their minds

Some people will take that to extremes in terms of not really telling their relatives their experiences. This can be very difficult for members of the family, for example if your husband or your wife has just experienced a heart attack and they don’t want to talk about it. The partner may find this distressing because they think they need to talk about it.

Is there a difference between how men and women cope?

There are differences in how men and women use social support in a general sense. In particular, older men who may have been brought up in more of a ‘stiff upper lip’ tradition may feel that they need to be the strong one around the house.

They need to be encouraged to share their feelings as far as possible. Having someone around to talk to isn’t just a question of sharing your feelings, it’s also about taking advice from them. They may be important in terms of supporting you in making the necessary changes in your life. Many older men, even in the modern world, still don’t do their own cooking and buying of food, so any changes that people make in terms of their diet are going to depend on the women in the house.

How can partners offer support?

You need to be there for that person when and if they want to talk, but some people do find it hard if their relatives are ‘over-solicitous’

It’s a delicate balance. You need to be there for that person when and if they want to talk, but some people do find it hard if their relatives are what I call ‘over-solicitous’ in trying to find out how the patient feels and in trying to do things for them. As a partner one needs to be very careful about that kind of thing. On the other hand you don’t want to carry on as if nothing had happened.

How do anxiety and depression differ?

They are rather different experiences. In relation to a heart attack, a person who becomes anxious is the sort of person who becomes worried that the problem may occur again and so may be very sensitive to the feelings of their bodies, whether they have got palpitations or shortness of breath.

At high levels of anxiety this can be problematic and stop people doing things because they will be concerned that it might have a bad effect.

A depressive response is a much more of a withdrawn response and a feeling of hopelessness almost. There’s a kind of inevitability about what might happen. Someone may vary between one and the other.

They do require different ways of managing those problems because the issues for the patients can be very different. We have been looking at different reactions and trying to understand why people experience one thing or the other and the extent to which they overlap.

What does your role as BHF Professor of Psychology involve?

I carry out research on psychological factors in relation to heart disease. This takes two forms: detailed lab research looking at the biological processes through which psychological factors might influence heart disease risk; and clinical studies where we study people who’ve experienced a heart attack or had cardiac surgery and look into the emotional parts of those experiences.

How do you conduct these clinical studies?

We identify people, for example those who’ve had a heart attack, as soon as possible after they have gone to hospital and ask them to take part in our studies. If they agree we interview them at various points, which might include interviewing them at hospital and sometimes at home. Some interviews may be as questionnaires; others will be face-to-face.

The people who take part in our studies are an important part of our research, and we’re grateful to them and to the BHF for its support.

BHF Professor Andrew Steptoe

Professor Andrew Steptoe is BHF Professor of Psychology at University College London (UCL). His research group focuses on understanding the biological processes through which stress and other emotions influence the cardiovascular system, and on how psychological adaptation following heart events and cardiac surgery affect long-term recovery.

Professor Steptoe worked for more than 20 years at St George’s Hospital before moving his research group to UCL in 2000 with BHF support.

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