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Table of Contents
Vol. 73, No. 6, 2004
Issue release date: November–December 2004
Psychother Psychosom 2004;73:344–352
(DOI:10.1159/000080387)

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

Grace S.L. · Abbey S.E. · Irvine J. · Shnek Z.M. · Stewart D.E.
aUniversity Health Network Women’s Health Program, bDepartment of Psychiatry, University of Toronto, cYork University, Toronto, and dCredit Valley Hospital, Mississauga, Canada

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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.



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References

  1. Frasure-Smith N: In-hospital symptoms of psychological stress as predictors of long-term outcome after acute myocardial infarction in men. Am J Cardiol 1991;67:121–127.
  2. Moser DK, Dracup K: Is anxiety early after myocardial infarction associated with subsequent ischemic and arrhythmic events? Psychosom Med 1996;58:395–401.
  3. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
  4. Crisp AH, Jones MG, Slater P: The Middlesex Hospital Questionnaire: A validity study. Br J Med Psychol 1978;51:269–280.
  5. Crown S, Crisp AH: A short clinical diagnostic self-rating scale for psychoneurotic patients. Br J Psychiatry 1966;112:917–923.
  6. Beitman BD, Mukerji V, Lamberti JW: Panic disorder in patients with chest pain and angiographically normal coronary patients arteries. Am J Cardiol 1989;63:1399–1403.
  7. Fleet R, Lavoie K, Beitman BD: Is panic disorder associated with coronary artery disease? A critical review of the literature. J Psychosom Res 2000;48:347–356.
  8. Jeejeebhoy FM, Dorian P, Newman DM: Panic disorder and the heart: A cardiology perspective. J Psychosom Res 2000;48:393–403.
  9. Rutledge T, Reis SE, Olson M, Owens J, Kelsey SF, Pepine CJ, Reichek N, Rogers WJ, Bairey Merz CN, Sopko G, Cornell CE, Sharaf B, Matthews KA: History of anxiety disorders is associated with a decreased likelihood of angiographic coronary artery disease in women with chest pain: The WISE study. J Am Coll Cardiol 2001;37:780–785.

    External Resources

  10. Chignon JM, Lepine JP, Ades J: Panic disorder in cardiac outpatients. Am J Psychiatry 1993;150:780–785.
  11. Kubzansky LD, Kawachi I, Weiss ST, Sparrow D: Anxiety and coronary heart disease: A synthesis of epidemiological, psychological, and experimental evidence. Ann Behav Med 1998;20:47–58.
  12. Abbey S, Stewart DE: Gender and psychosomatic aspects of ischemic heart disease. J Psychosom Res 2000;48:417–423.
  13. Williams RB: Do benzodiazepines have a role in the prevention or treatment of coronary heart disease and other major disorders? J Psychiatr Res 1990;24(suppl 2):51–56.
  14. Vingerhoets G: Cognitive, emotional and psychosomatic complaints and their relation to emotional status and personality following cardiac surgery. Br J Health Psychol 1998;3:159–169.
  15. Haines AP, Imeson JD: Phobic anxiety and ischaemic heart disease. Br Med J 1987;295:297–299.
  16. Kawachi I, Sparrow D, Vokonas PS, Weiss ST: Symptoms of anxiety and risk of coronary heart disease. The Normative Aging Study. Circulation 1994;90:2225–2229.
  17. Kawachi I, Colditz GA, Ascherio A, Rimm EB, Giovannucci E, Stampfer MJ, Willett WC: Prospective study of phobic anxiety and risk of coronary heart disease in men. Circulation 1994;89:1992–1997.
  18. Herrmann C, Brand-Driehorst S, Buss U, Ruger U: Effects of anxiety and depression on 5-year mortality in 5,057 patients referred for exercise testing. J Psychosom Res 2000;48:455–462.
  19. Grace SL, Abbey S, Shnek Z, Irvine J, Franche RL, Stewart D: Cardiac rehabilitation. 2. Referral and participation. Gen Hosp Psychiatry 2002;24:127–134.
  20. Schocken DD, Greene AF, Worden TJ, Harrison EE, Spielberger CD: Effects of age and gender on the relationship between anxiety and coronary artery disease. Psychosom Med 1987;49:118–126.
  21. Simon G, Ormel J, VonKorff M, Barlow W: Health care costs associated with depressive and anxiety disorders in primary care. Am J Psychiatry 1995;152:352–357.
  22. Brezinka V, Dusseldorp E, Maes S: Gender differences in psychosocial profile at entry into cardiac rehabilitation. J Cardiopulm Rehabil 1998;18:445–449.
  23. Schuster PM, Waldron J: Gender differences in cardiac rehabilitation patients. Rehabil Nurs 1991;16:248–253.
  24. Halm MA, Penque S: Heart failure in women. Prog Cardiovasc Nurs 2000;15:121–133.
  25. Bankier B, Littman AB: Psychiatric disorders and coronary heart disease in women – A still neglected topic: Review of the literature from 1971 to 2000. Psychother Psychosom 2002;71:133–140.
  26. Eaker E, Pinsky J, Castelli W: Myocardial infarction and coronary death among women: Psychosocial predictors from a 20-year follow-up of women in the Framingham Study. Am J Epidemiol 1992;135:854–864.
  27. Lane D, Carroll D, Ring C, Beevers DG, Lip GYH: Effects of depression and anxiety on mortality and quality-of-life 4 months after myocardial infarction. J Psychosom Res 2000;49:229–238.
  28. Killip T, Kimball JT: Treatment of myocardial infarction in a coronary care unit: A two-year experience with 250 patients. Am J Cardiol 1967;20:457–464.
  29. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.
  30. Steer RA, Cavalieri TA, Leonard DM, Beck AT: Use of the Beck Depression Inventory for primary care to screen for major depression disorders. Gen Hospital Psychiatry 1999;21:106–111.
  31. Frasure-Smith N, Lesperance F, Talajic M: Depression following myocardial infarction: Impact on six-month survival. JAMA 1993;270:1819–1825.
  32. Shnek ZM, Irvine J, Stewart D, Abbey S: Psychological factors and depressive symptoms in ischemic heart disease. Health Psychol 2001;20:141–145.
  33. Beck AT, Steer RA, Garbin MG: Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clin Psychol Rev 1988;8:77–100.

    External Resources

  34. Spitzer RL, Williams JBW, Kroenke K, Linzer M, et al: Utility of a new procedure for diagnosing mental disorders in primary care: The PRIME-MD 1000 Study. JAMA 1994;272:1749–1756.
  35. Hahn SR, Kroenke K, Williams JBW, Spitzer RL: Primary care evaluation of mental disorders; in Maruish ME (ed): The Use of Psychosocial Testing for Treatment Planning and Outcomes Assessment, ed 2. Mahwah, Lawrence Erlbaum Associates, 1999, pp 871–920.
  36. Van Hook MP, Berkman B, Dunkle R: Assessment tools for general health care settings: PRIME-MD, OARS, and SF-36. Health Soc Work 1996;21:230–234.
  37. Tabachnick BG, Fidell LS: Using Multivariate Statistics, ed 4. New York, Harper Collins College Publishers, 2001.
  38. Buchanan LM, Cowan M, Burr R, Waldron C, Kogan H: Measurement of recovery from myocardial infarction using heart rate variability and psychological outcomes. Nurs Res 1993;42:74–78.
  39. Hayward C: Psychiatric illness and cardiovascular disease risk. Epidemiol Rev 1995;17:129–137.
  40. Morris A, Baker B, Devins GM, Shapiro CM: Prevalence of panic disorder in cardiac outpatients. Can J Psychiatry 1997;42:185–190.
  41. Frasure-Smith N, Lesperance F, Juneau M, Talajic M, Bourassa MG: Gender, depression, and one-year prognosis after myocardial infarction. Psychosom Med 1999;61:26–37.
  42. Ungar WJ, Coyte PC: Health services utilization reporting in respiratory patients: Pharmacy medication monitoring program advisory board. J Clin Epidemiol 1998;51:1335–1342.
  43. Reijneveld SA, Stronks K: The validity of self-reported use of health care across socioeconomic strata: A comparison of the survey and registration data. Int J Epidemiol 2001;30:1407–1414.
  44. Leyton M, Belanger C, Martial J, Beaulieu S, Corin E, Pecknold J, Ying Kin NMKN, Meaney M, Thavundayil J, Larue S, Nair NPV: Cardiovascular, neuroendocrine, and monoaminergic responses to psychological stressors: Possible differences between remitted panic disorder patients and healthy controls. Biol Psychiatry 1996;40:353–360.
  45. Lewin RJ, Furze G, Robinson J, Griffith K, Wiseman S, Pye M, Boyle RA: Randomised controlled trial of a self-management plan for patients with newly diagnosed angina. Br J Gen Pract 2002;52:194–196.

    External Resources

  46. Grace SL, Abbey SE, Shnek ZM, Irvine J, Franche RL, Stewart DE: Cardiac rehabilitation. 1. Review of psychosocial factors. Gen Hosp Psychiatry 2002;24:121–126.
  47. Yoshida T, Kohzuki M, Yoshida K, Hiwatari M, Kamimoto M, Yamamoto C, Meguro S, Endo N, Kato A, Kanazawa M, Sato T: Physical and psychological improvements after phase II cardiac rehabilitation in patients with myocardial infarction. Nurs Health Sci 1999;1:163–170.
  48. Cossette S, Frasure-Smith N, Lesperance F: Clinical implications of a reduction in psychological distress on cardiac prognosis in patients participating in a psychosocial intervention program. Psychosom Med 2001;63:257–266.
  49. Writing Committee for the ENRICHD Investigators: Effects of treating depression and low perceived social support on clinical events after myocardial infarction: The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA 2003;289:3106–3116.
  50. Glassman AH, O’Connor CM, Califf RM, et al: Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 2002;288:701–709.
  51. Ketterer MW: Cognitive/behavioral therapy of anxiety in the medically ill: Cardiac settings. Semin Clin Neuropsychiatry 1999;4:148–153.
  52. Khawaja IS, Feinstein RE: Cardiovascular effects of selective serotonin reuptake inhibitors and other novel antidepressants. Heart Dis 2003;5:153–160.


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