Emotional coping is a better predictor of cardiac prognosis than depression and anxiety

Abstract

Objective: We compared, in a prospective study on patients with acute coronary syndrome, the predictive effect of a depression or anxiety diagnosis and of emotion-focused, problem-focused and dysfunctional coping strategies, as detected early after an acute event, on patients' left ventricular ejection fraction (LVEF), a reliable prognostic index of disease severity, at a three-month follow up.Methods: Ninety consecutive patients following an acute coronary syndrome event (83.3% men; mean age 56.9 ± 8.9 years) were included in the study. Demographic and clinical characteristics, presence of depression and anxiety disorders (MINI), and active use of emotion-focused, problemfocused and dysfunctional coping strategies (Brief Cope) were assessed at the time of enrolment.LVEF at a three-month follow up was used as the outcome measure. Results: The medical predictors of LVEF accounted for 10.6% of the variance of LVEF at follow up. Emotion-focused coping strategies significantly contributed for an additional 6.1%, while the presence of a depression and/or anxiety disorder was not a significant predictor of LVEF at follow up, nor were dysfunctional and problem-focused coping strategies. Conclusion: Emotion-focused coping strategies at the time of the cardiac event were the only reliable psychological predictor of disease severity at a three-month follow up. These findings hint to the possibility that variables such as emotional coping may be a fruitful target for psychological treatments directed at cardiac patients in primary care settings.Keywords: acute coronary syndrome; cardiac rehabilitation; constructivism; depression; emotionfocused coping.Abbreviations: ACS, acute coronary syndrome; BMI, body mass index; CABG, coronary artery bypass graft; DSM, diagnostic and statistical manual of mental disorders; ICD, international classification of diseases; LVEF, left ventricular ejection fraction; MINI, mini-international neuropsychiatric interview; NSTEMI, non-ST-elevation myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST elevation myocardial infarction.

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