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.