Cardiac anxiety in people with and without coronary atherosclerosis

Abstract

Many studies have shown that cardiac anxiety when occurring in the absence of coronary artery disease is common and quite costly. The Cardiac Anxiety Questionnaire (CAQ) is an 18 item selfreport measure that assesses anxiety related to cardiac symptoms. In order to better understand the construct of cardiac anxiety, a factor analysis was conducted on CAQ data from 658 individuals who were self-or physician-referred for electron beam tomographic screening to determine whether clinically significant coronary atherosclerosis was present. A four-factor solution was judged to provide the best fit with the results reflecting the following factor composition: heart focused attention, avoidance of activities that bring on symptoms, worry or fear regarding symptoms, and reassurance-seeking. Factorial invariance across groups was also assessed to determine whether the factor structure of the CAQ was similar in individuals with and without clear evidence of coronary atherosclerosis. The factor structure of the CAQ did not differ between the two groups. However, the group without coronary atherosclerosis had significantly higher mean scores on their attention and worry/fear factors suggesting that people without a diagnosed cardiac condition pay more attention to and worry more about their cardiac related symptoms than those people who have coronary atherosclerosis. KeywordsAnxiety sensitivity; cardiac; anxiety; confirmatory factor analysis; factorial invariance; configural invariance; metric invariance Fear of bodily sensations, one component of anxiety sensitivity, has been found to play a central role in panic disorder (Cox, 1996;McNally &Eke, 1996;Reiss and McNally, 1985) and is likely to play a role in its etiology (Schmidt, Lerew, & Jackson, 1997) and persistence over time (Clark, 1988). Fear of anxiety sensations, as measured by the Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986), has been shown to reflect specific dimensions referring to somatic, social, and psychological consequences (e.g., Zinbarg, Brown, & Barlow, 1997). Taylor and Cox (1998) found that an expanded measure of anxiety sensitivity, the Anxiety Sensitivity Profile (ASP), included four lower-order factors composed of items that assess bodily sensations pertaining to fears of respiratory, cardiac, cognitive, and gastrointestinal symptoms. Based upon such evidence, researchers are increasingly exploring the possibility that a fear of certain bodily sensations may be a psychological risk factor for other types of anxiety pathology (e.g., Eifert, 1992;Zinbarg, Mohlman, & Hong, 1999).There has been a considerable amount of research examining the relationship between anxiety, usually in the form of panic disorder and chest pain (e.g., Beck, Berisford, Taegtmeyer, & Bennett, 1990;Beitman, Mukerji, Lamberti, Schmid, DeRosear, et al., 1989). This phenomenon is often referred to as non-cardiac chest pain. Many of these studies have focused exclusively on chest pain as a primary symptom, because the potential seriousness of thi...

Depressive Symptoms, Cardiac Anxiety, and Fear of Body Sensations in Patients with Non-Cardiac Chest Pain, and Their Relation to Healthcare-Seeking Behavior: A Cross-Sectional Study

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A New CBT Model of Panic Attack Treatment in Comorbid Heart Diseases (PATCHD): How to Calm an Anxious Heart and Mind

“…When panic disorder is suspected prior to an initial consultation, we additionally administer the Cardiac Anxiety Questionnaire (CAQ; Eifert et al, 2000) since panic and cardiac patients tend to score significantly higher on fear and hypervigilance items than nonpanic and cardiac patients (Marker, Carmin, & Ownby, 2008;Sardinha et al, 2013). Moreover, high cardiac anxiety impacts treatment adherence and prognosis independently of meeting full criteria for panic disorder (O'Connor et al, 2009;Yohannes, Yalfani, Doherty, & Bundy, 2007).…”