What is the clinical evidence from this study?

Study design: Systematic Review. Population: Cardiovascular disease (n=9628). Intervention: Heart-focused anxiety (HFA). Primary outcome: Major adverse cardiac events and mortality post-MI (HR 1.30-1.59).

What does this research mean for the field?

Heart-focused anxiety affects 15% to 49% of patients with cardiovascular disease, independently predicts major adverse cardiac events and mortality post-myocardial infarction, and can be mitigated by cardiac rehabilitation and psychological interventions. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

Synthesize evidence on the prevalence, predictors, prognostic impact, and rehabilitation implications of heart-focused anxiety in adults with cardiovascular disease.

September 30, 2026European Journal of Preventive CardiologyOpen Access

Cardiac Anxiety in Adults with Cardiovascular Disease: Prevalence, Predictors, and Implications for Cardiac Rehabilitation - A Systematic Review

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Key result

Heart-focused anxiety is linked to up to ~59% higher post-MI MACE and mortality risk.

HR 1.30-1.59
n=9,628

Why the study?

Heart-focused anxiety is rarely screened for in cardiac rehabilitation and no prior systematic review has synthesized evidence on its prevalence, predictors, or implications for cardiac rehabilitation.

Population

9,628 adults with confirmed cardiovascular disease across eight countries

Design

Systematic review of cross-sectional, cohort, validation, and intervention studies

Authors

HNHenry Eziefule NwankwoUniversity of Chester KOKayode OgunniyiCross-Cutting Cardiology COChisom OkezueMontefiore Health System

Discussion

Member takes

Overview

HFA warrants routine screening in CR given its prevalence and independent prognostic value; leaves open whether targeted interventions improve outcomes.

Key Points

Synthesize evidence on the prevalence, predictors, prognostic impact, and rehabilitation implications of heart-focused anxiety in adults with cardiovascular disease.
Searched PubMed, CINAHL, PsycINFO, and the Cochrane Library following PRISMA 2020 guidelines (PROSPERO CRD420261394690).
Included 26 cross-sectional, cohort, validation, and intervention studies involving 9,628 patients across eight countries using the Cardiac Anxiety Questionnaire (CAQ) or Herzangstfragebogen (HAF-17).
Appraised study quality using NIH NHLBI tools and Cochrane RoB 2, followed by narrative synthesis.
Clinically elevated heart-focused anxiety prevalence ranged from 15% to 49% across diverse cardiac populations, correlating with depressive symptoms, illness perceptions, and physical inactivity.
Heart-focused anxiety independently predicted major adverse cardiac events and post-infarction mortality in two prospective cohorts (hazard ratio [HR] range 1.30–1.59), with avoidance behavior serving as the primary driver.
Standard and specialized psychocardiological cardiac rehabilitation, early mobilization, and device therapy were associated with significant reductions in heart-focused anxiety.

Study Design

Type

Systematic Review (n=9,628)

Multicenter

Yes

Structured PICO

Population

9,628 adults with confirmed cardiovascular disease from 26 studies assessing the prevalence and impact of heart-focused anxiety.

Outcome

Prevalence, predictors, and implications of Heart-focused anxiety (HFA) measured using the Cardiac Anxiety Questionnaire (CAQ) or Herzangstfragebogen (HAF-17)patient reported

Main Result

Effect estimate: HR 1.30-1.59

Heart-focused anxiety is highly prevalent among CVD patients and is associated with worse clinical outcomes, suggesting a need for routine screening during cardiac rehabilitation.

Limitations

Evidence remains largely observational

Cite This Study

Nwankwo et al. (2026) conducted a systematic review in Cardiovascular disease (n=9,628). Heart-focused anxiety (HFA) was evaluated on Major adverse cardiac events and mortality post-MI (HR 1.30-1.59). Heart-focused anxiety is prevalent (15-49%) in cardiovascular disease and independently predicts major adverse cardiac events and mortality post-MI (HR range 1.30-1.59).

synapsesocial.com/papers/6abc576efbfca106a1247ee5 https://doi.org/10.1093/eurjpc/zwag509

View Full Paper

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September 30, 2026European Journal of Preventive CardiologyOpen Access

Cardiac Anxiety in Adults with Cardiovascular Disease: Prevalence, Predictors, and Implications for Cardiac Rehabilitation - A Systematic Review

View Full Paper

Ask AI

Bookmark

Key result

Heart-focused anxiety is linked to up to ~59% higher post-MI MACE and mortality risk.

HR 1.30-1.59
n=9,628

Why the study?

Population

9,628 adults with confirmed cardiovascular disease across eight countries

Design

Systematic review of cross-sectional, cohort, validation, and intervention studies

Authors

HNHenry Eziefule NwankwoUniversity of Chester KOKayode OgunniyiCross-Cutting Cardiology COChisom OkezueMontefiore Health System

Discussion

Member takes

Overview

HFA warrants routine screening in CR given its prevalence and independent prognostic value; leaves open whether targeted interventions improve outcomes.

Key Points

Synthesize evidence on the prevalence, predictors, prognostic impact, and rehabilitation implications of heart-focused anxiety in adults with cardiovascular disease.
Searched PubMed, CINAHL, PsycINFO, and the Cochrane Library following PRISMA 2020 guidelines (PROSPERO CRD420261394690).
Included 26 cross-sectional, cohort, validation, and intervention studies involving 9,628 patients across eight countries using the Cardiac Anxiety Questionnaire (CAQ) or Herzangstfragebogen (HAF-17).
Appraised study quality using NIH NHLBI tools and Cochrane RoB 2, followed by narrative synthesis.
Clinically elevated heart-focused anxiety prevalence ranged from 15% to 49% across diverse cardiac populations, correlating with depressive symptoms, illness perceptions, and physical inactivity.
Heart-focused anxiety independently predicted major adverse cardiac events and post-infarction mortality in two prospective cohorts (hazard ratio [HR] range 1.30–1.59), with avoidance behavior serving as the primary driver.
Standard and specialized psychocardiological cardiac rehabilitation, early mobilization, and device therapy were associated with significant reductions in heart-focused anxiety.

Study Design

Type

Systematic Review (n=9,628)

Multicenter

Yes

Structured PICO

Population

9,628 adults with confirmed cardiovascular disease from 26 studies assessing the prevalence and impact of heart-focused anxiety.

Outcome

Prevalence, predictors, and implications of Heart-focused anxiety (HFA) measured using the Cardiac Anxiety Questionnaire (CAQ) or Herzangstfragebogen (HAF-17)patient reported

Main Result

Effect estimate: HR 1.30-1.59

Heart-focused anxiety is highly prevalent among CVD patients and is associated with worse clinical outcomes, suggesting a need for routine screening during cardiac rehabilitation.

Limitations

Evidence remains largely observational

Cite This Study

synapsesocial.com/papers/6abc576efbfca106a1247ee5 https://doi.org/10.1093/eurjpc/zwag509

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