Symptom dimensions of anxiety following myocardial infarction: Associations with depressive symptoms and prognosis.

Abstract

ObjectiveDifferential associations of symptom dimensions with prognosis in myocardial infarction (MI) patients have been shown for depression, but no studies have focused on anxiety dimensions.The aim of this study was to assess the association between somatic and psychological symptoms of anxiety following acute MI with adverse prognosis and to assess the overlap between anxiety and depression dimensions. MethodsPatients (n=418) were assessed on demographic and clinical variables. The Hamilton Anxiety and Depression Rating Scales were used to measure anxiety and depression 2 months post-MI.Mean follow-up period was 3.8 years and the endpoint consisted of all-cause mortality and recurrent MI. ResultsAfter adjustment for demographic and clinical variables, somatic anxiety was significantly associated with recurrent MI and mortality (HR: 1.32; 95% CI: 1.03-1.69; p=0.03), while a trend was shown for an association between psychological anxiety and outcome (HR: 1.29; 95% CI: 0.99-1.67; p=0.06). The total anxiety score of the HARS was the strongest predictor of recurrent MI and mortality (HR: 1.38; 95% CI: 1.07-1.78; p=0.02). The HARS and the HDRS were highly correlated (r=0.86; p<0.01). Dimensions consisting of psychological distress (HR: 1.29; 95% CI:1.02-1.63; p=0.03) and cardiopulmonary/autonomic symptoms (HR: 1.36; 95% CI: 1.06-1.75; p=0.02) also predicted outcome in adjusted analyses. ConclusionsAnxiety was associated with adverse prognosis in MI patients with significant associations for somatic anxiety and total anxiety. When combining anxiety and depression items, psychological distress and cardiopulmonary/autonomic symptoms predicted recurrent MI and mortality. Future 4 research might better focus on dimensions of anxiety and depression simultaneously in MI patients.

Psycho-emotional disorders as incoming risk factors for myocardial infarction with non-obstructive coronary arteries

“…The relation between MI and psychiatric disorders has already been described [22,23] but it is also known that psychiatric patients have higher chance of cardiovascular risk factors [24], unlike what was shown in this study, MINOCA patients had a better cardiovascular profile. Recently, a study suggested that optimistic patients have a better prognosis after MI [25], while others linked heart disease with a worse outlook [26,27]. This concurs with the present hypothesis that negative emotions could be a risk factor for MINOCA.…”

Determinants of Dyspnea in Chronic Heart Failure

“…Our current findings show that anxiety was strongly associated with dyspnea complaints in the fully adjusted model. We used the Hamilton anxiety rating scale to assess anxiety, which does contain a somatic component (22). In search of a mechanism, we split up somatic and cognitive anxiety symptoms, and found that cognitive anxiety symptoms are not associated with dyspnea, while somatic symptoms, especially related to cardiovascular (e.g.…”

“…Somatic and cognitive subscale scores have been calculated by summing the items belonging to these symptom dimensions (22). In the current dataset, Cronbach's alpha was .80 at baseline and .78 at 12 months follow-up.…”

Fear and distress disorders as predictors of heart disease: A temporal perspective

“…Fear disorders are further specifically characterized by underlying symptom dimensions of somatic arousal and phobic fear. These characteristics have been repeatedly shown to predict incident CHD (Albert et al, 2005; Nabi et al, 2010) and CHD prognosis (Watkins et al, 2010; Roest et al, 2014), although not all study results have been consistent. In a relatively small sample of patients who were assessed for anxiety and depression before undergoing coronary artery bypass graft surgery, neither fear disorder (a cluster including PD, agoraphobia and SAD) nor anxious arousal was predictive of cardiovascular and cerebrovascular events.…”

“…In this model GAD is classified as a distress disorder since it is more strongly linked to depression than to fear disorders, which are characterized by phobic fear and somatic arousal (Clark & Watson 1991; Watson 2005; Brown & McNiff 2009; Den Hollander-Gijsman et al, 2010). Phobic fear and somatic arousal may be particularly strongly related to the development of heart disease and adverse prognosis in patients with CHD (Albert et al, 2005; Watkins et al, 2010; Nabi et al, 2010; Roest et al, 2014). Therefore, categorizing depressive and anxiety disorders into fear and distress disorders may be more useful than comparing anxiety and depressive disorders, or examining all disorders separately, when investigating the association between these disorders and heart disease.…”