Association of anhedonia with recurrent major adverse cardiac events and mortality 1 year after acute coronary syndrome

Context: Depression consistently predicts recurrent events and mortality in patients with acute coronary syndrome (ACS), but it has 2 core diagnostic criteria with distinct biological correlates - depressed mood and anhedonia (loss of pleasure or interest). Objective: To determine if depressed mood and/or anhedonia predict 1-year medical outcomes for patients with ACS. Design: Observational cohort study of post-ACS patients hospitalized between May 2003 and June 2005. Within 1 week of admission, patients underwent a structured psychiatric interview assessing clinically impairing depressed mood, anhedonia, and major depressive episode (MDE). Also assessed were the Global Registry of Acute Coronary Events risk score, Charlson comorbidity index, left ventricular ejection fraction, antidepressant use, and depressive symptom severity using the Beck Depression Inventory. Setting: Cardiac units of 3 university hospitals in New York and Connecticut. Participants: Consecutive sample of 453 patients with ACS (age, 25-93 years; 42% women). Main Outcomes Measures: All-cause mortality (ACM) and documented major adverse cardiac events (MACEs) - myocardial infarction, hospitalization for unstable angina, or urgent/emergency coronary revascularization) - actively surveyed for 1 year after admission. Results: There were 67 events (16 deaths and 51 MACEs; 14.8%): 108 (24%) and 77 (17%) patients had anhedonia and depressed mood, respectively. Controlling for sex, age, and medical covariates, anhedonia (adjusted hazard ratio, 1.58; 95% confidence interval, 1.16-2.14; P < .01) was a significant predictor of combined MACE and ACM, but depressed mood was not. Anhedonia continued to significantly predict outcomes (P < .05) when additionally controlling for MDE diagnosis or depressive symptom severity. Findings were confirmed using depressed mood and anhedonia subscores from the Beck Depression Inventory in place of clinician interview ratings. Conclusions: Anhedonia identifies risk of MACE and ACM beyond that of established medical prognostic indicators, including MDE and depressive symptom severity. Correlates of anhedonia may add to the understanding of the link between depression and heart disease.