What is the clinical evidence from this study?

Study design: Cohort. Population: Myocardial infarction (n=193). Intervention: Cardiac anxiety (per 1-point increase in CAQ score) vs. Lower CAQ score. Primary outcome: Major adverse cardiac event (MACE): readmission for ischemic cardiac disease or all-cause mortality (HR 1.59, 95% CI 1.04-2.43, p=0.033).

What does this research mean for the field?

Cardiac anxiety at hospital admission, particularly anxiety-related avoidance of exercise, significantly predicts major adverse cardiac events following a myocardial infarction, independent of cardiac disease severity and depression. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

August 19, 2016Open Access

Prognostic association of cardiac anxiety with new cardiac events and mortality following myocardial infarction

Resultado clave

Cardiac anxiety at hospital admission significantly predicted a major adverse cardiac event (HR 1.59) over a mean follow-up of 4.2 years, independent of cardiac disease severity and depression.

Diseño del estudio

Tipo

Cohort (n=193)

Multicéntrico

PICO estructurado

Does elevated cardiac anxiety predict major adverse cardiac events in patients after myocardial infarction?

Población

193 adults with recent myocardial infarction, aged 85 years or younger, followed for a mean of 4.2 years to assess the prognostic impact of cardiac anxiety.

Exposición

Elevated cardiac anxiety as measured by the Cardiac Anxiety Questionnaire (CAQ) at baseline and 4 months post-discharge

Resultado

Major adverse cardiac event (MACE): readmission for ischemic cardiac disease or all-cause mortality at mean follow-up of 4.2 yearscomposite

Cardiac anxiety, particularly anxiety-related avoidance of exercise, is an independent prognostic factor for major adverse cardiac events following myocardial infarction.

Resultado numérico

Hazard Ratio: 1.59 (95% CI 1.04–2.43)

valor p: p=0.033

Limitaciones

Absence of information on formal diagnosis of anxiety and/or depressive disorders or psychiatric treatment
Physical activity was not assessed, which might mediate the effect of avoidance
Excluded the most severely ill patients and those with milder symptoms relocated within 2 days
Relatively small sample size limits the statistical power for gender-specific findings

Resumen

Background General anxiety and depressive symptoms following a myocardial infarction are associated with a worse cardiac prognosis. However, the contribution of specific aspects of anxiety within this context remains unclear. Aims To evaluate the independent prognostic association of cardiac anxiety with cardiac outcome after myocardial infarction. Method We administered the Cardiac Anxiety Questionnaire (CAQ) during hospital admission (baseline, n = 193) and 4 months ( n = 147/193) after discharge. CAQ subscale scores reflect fear, attention, avoidance and safety-seeking behaviour. Study end-point was a major adverse cardiac event (MACE): readmission for ischemic cardiac disease or all-cause mortality. In Cox regression analysis, we adjusted for age, cardiac disease severity and depressive symptoms. Results The CAQ sum score at baseline and at 4 months significantly predicted a MACE (HR baseline = 1.59, 95% CI 1.04–2.43; HR 4-months = 1.77, 95% CI 1.04–3.02) with a mean follow-up of 4.2 (s.d. = 2.0) years and 4.3 (s.d. = 1.7) years respectively. Analyses of subscale scores revealed that this effect was particularly driven by avoidance (HR baseline = 1.23, 95% CI 0.99–1.53; HR 4-months = 1.77, 95% CI 1.04–1.83). Conclusions Cardiac anxiety, particularly anxiety-related avoidance of exercise, is an important prognostic factor for a MACE in patients after myocardial infarction, independent of cardiac disease severity and depressive symptoms.

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