Prospective Examination of Anxiety Persistence and Its Relationship to Cardiac Symptoms and Recurrent Cardiac Events

Abstract

Background: The current study builds on previous research demonstrating a link between anxiety and inhospital recurrent ischemic and arrhythmic events, by examining the effects of persistent anxiety on recurrent events 1 year later. Methods: 913 patients with unstable angina (UA) and myocardial infarction (MI) from 12 coronary care units were recruited, and follow-up data were collected at 6 and 12 months after the event. Measures included cardiac symptomatology, healthcare utilization, the anxiety subscale of the Primary Care Evaluation of Mental Disorders , the phobic anxiety subscale of the Middlesex Hospital Questionnaire, and the Beck Depression Inventory. Results: Over one third of participants with UA and MI experienced elevated anxiety at the time of the ischemic event, and these symptoms persisted for 1 year in 50% of anxious participants. Although participants with anxiety reported more atypical cardiac symptomatology, the prevalence of typical cardiac symptoms such as chest pain did not differ based on anxiety. After controlling for the severity of the coronary event, family income, sex, diabetes, and smoking, the following variables were significantly predictive of self-reported recurrent cardiac events at 6 months or 1 year: older age, family history of cardiovascular disease, greater depressive symptomatology at baseline, and anxiety at 6 months. Only 38% of anxious patients were asked about such symptoms, indicating underutilization of effective psychotherapeutic treatment. Conclusions: Over and above the effects of depressive symptomatology (among other confounding variables), nonphobic anxiety appears to have a negative effect on self-reported outcome following an ischemic coronary event. Anxiety symptomatology is underrecognized and undertreated, and examination of effects of treatment on secondary prevention must be pursued.

Mokken scaling analysis of the Hospital Anxiety and Depression Scale in individuals with cardiovascular disease

“…As outlined previously, anxiety and depression are both prognostic risk factors for CVD, highlighting the need to be able to assess these disorders via the HADS (49)(50)(51)(52)(53)(54)(55). Having the ability to quantify mutually exclusive levels of anxiety and depression is an integral component of assessment when the prognoses are specifically predicted by one or the other disorder; however, in the case of CVD, both anxiety and depression are prognostic risk factors, negating the need to differentiate between these disorders.…”

Psychological symptom clusters, psychiatric comorbidity and poor self-reported health status following myocardial infarction

“…Several large studies have noted a relationship between phobic anxiety and sudden cardiac death (41,42). In addition, Grace et al (18) reported nonphobic anxiety to have a negative effect on self-reported recurrent cardiac events following an ischemic coronary event. However, data linking the various forms of anxiety to CAD are relatively rare and more work is needed.…”

“…The BDI is a reliable and wellvalidated measure of depressive symptomatology (15,16) and is the most widely used self-report measure of depression. BDI scores 10 or higher are indicative of at least mild to moderate symptoms of depression and have been associated with poor prognosis in MI patients (4,6,17,18).…”

“…KMO (0.95) and Bartlett's test of 8,12,18,19;BDI Item 17). The labeling of the components was based on previous literature (22,23).…”

Association Between the Weight Loss and Anxiety, Depression After Percutaneous Transluminal Coronary Angioplasty: A Need for Pre-Discharged Counseling

“…Despite their high prevalence and serious impact, mood and anxiety symptoms go unrecognized and untreated in most ACS patients and such symptoms (rather than being transient reactions to ACS) persist for months and beyond. The mechanisms by which depression and anxiety are linked to these negative medical outcomes are likely a combination of the effects of these conditions on inflammation, catecholamine's, heart rate variability, and endothelial function, along with effects on health promoting behavior [19][20][21][22][23][24].…”