A qualitative study of anxiety and depression following a heart attack in the United Kingdom

Background

Heart attacks affect around 100,000 individuals annually in the United Kingdom (UK) and represent a significant public health burden. Survivors may develop depression and anxiety, with prevalence estimates of up to 24% and 12% respectively, increasing mortality risk. Despite this burden, mental health support is rarely embedded within cardiac recovery pathways, and no qualitative study in the UK has examined how survivors experience these symptoms.

Methods

Twenty heart attack survivors reporting anxiety or depression were recruited through cardiovascular charities and completed semi-structured interviews with a mean duration of 69 minutes. Data were analysed using reflexive thematic analysis with a critical realist approach.

Results

Four themes and ten subthemes were developed. Survivors described a trajectory from traumatic experience through anxiety driven by fear and uncertainty to depression linked to loss of identity. Social disconnection and unexpected career loss compounded emotional recovery. Emotional distress was routinely dismissed within cardiac care, generating internalised stigma and discouraging help-seeking. Protective factors were identified at individual levels, including health knowledge; service levels, including empathetic follow-up and peer support; and societal levels, including awareness and financial support.

Conclusions

Heart attack survivors may experience a complex survivorship process, yet the emotional impact is often overlooked. Anxiety and depression were shaped by individual, social, and healthcare-related factors, representing a significant public mental health concern. There is a need for flexible psychosocial support embedded within cardiac recovery pathways across multiple levels, including peer networks, empathetic healthcare follow-up, and financial support. Our study provides a foundation for developing survivor-centred interventions that prioritise mental health within cardiac care.

Key messages

• Heart attack survivors experience complex anxiety and depression shaped by trauma, social disconnection, and inadequate emotional support within cardiac care.

• Psychosocial interventions must operate across individual, service, and societal levels to address survivors’ unmet psychological needs.