Psychotropic drugs, such an antidepressants and benzodiazepines, are associated with an almost doubled risk of premature death in patients with heart conditions, according to research published in the European Journal of Cardiovascular Nursing.

While previous studies have found an association between symptoms of anxiety and poor health outcomes, including death, in patients with heart disease, this study considered whether this link might be explained by the use of psychotropic medicine.

The study found that nearly one in five patients with heart disease use mental health drugs, with one in three suffering with anxiety.

One in five patients with heart disease use mental health drugs

The study enrolled nearly 13,000 participants hospitalised for ischaemic heart disease, arrhythmias, heart failure or valvular heart disease. Each participant completed a questionnaire at hospital discharge, and were classified as having anxiety if they scored eight of higher on the Hospital Anxiety and Depression Scale (HADS-A).

The researchers then looked at which patients were taking psychotropic medication using national registers. Participants were defined as users of psychotropic drugs if they had collected at least one prescription during the six months prior to hospital admission.

Patients were followed up one year following hospital discharge, and the researchers found that nearly one in five (18%) used psychotropic drugs. The most commonly used drugs were benzodiazepines (68%) and antidepressants (55%).

Use of psychotropic medications was higher among women, older patients, smokers, widowed patients, those with less education, and patients with greater numbers of co-existing health problems.

The study also found that psychotropic drug use was twice has high in patients with anxiety (28%) compared to those without anxiety (14%).

Patients with heart disease who suffer from anxiety should inform their doctor

The one-year death rate was significantly higher for users of psychotropic drugs (6%) compared to non-users (2%), and psychotropic medication was associated with 1.90 higher odds of all cause death during the first year following discharge. The presence of anxiety was associated with 1.81 higher odds of all-cause death during the same time period.

When the analyses were also adjusted for the use of psychotropic medication prior to hospitalisation and the presence of anxiety, the associations became weaker, at 1.73 and 1.67 respectively.

As study author Dr. Pernille Fevejle Cromhout of Copenhagen University Hospital, Denmark explains: “The weakening of the relationships suggests that the link between psychotropic medications and death is influenced by the presence of anxiety. And, similarly, that the connection between anxiety and death is influenced by the use of psychotropic medications.”

She added: “Patients with heart disease who suffer from anxiety should inform the healthcare professionals involved in their treatment as they would do with any other co-existing condition. They should also ask that their anxiety is recognised as important and equal to their heart disease.”