Early anxiety following acute myocardial infarction as a predictor of long-term psychological outcomes – Which screening method is most effective?

Background Acute myocardial infarction (AMI) is not only a life-threatening somatic event but also a major psychological stressor. Acute anxiety is common in the early post-AMI phase and may contribute to persistent symptoms of anxiety, depression, and post-traumatic stress. Despite its clinical relevance, anxiety is not routinely assessed in acute cardiology settings. Systematic early screening could provide a feasible approach to identifying patients at risk for adverse long-term mental health outcomes. This study compared different methods of early anxiety assessment after AMI regarding their prognostic validity for long-term psychological symptoms. Methods 128 AMI patients were recruited from the Department of Cardiology of our University Hospital. After clinical stabilization, state and trait anxiety were assessed using the State-Trait Anxiety Inventory (STAI [1]). Clinician-rated anxiety was measured with the Hamilton Anxiety Rating Scale (HAM-A [2]). One year after AMI, 34 patients participated in a structured telephone follow-up. Anxiety symptoms were reassessed using the HAM-A, depressive symptoms with the Hamilton Depression Rating Scale (HAMD-17 [3]), and post-traumatic stress symptoms with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5 [4]). Correlation and linear regression analyses examined the prognostic value of early anxiety measures for long-term outcomes. Results Early state anxiety (STAI-State) showed significant moderate correlations with anxiety (r = .51, p = .002, R² = .259), depressive (r = .58, p < .001, R² = .331), and post-traumatic stress symptoms (r = .43, p = .011, R² = .185) at follow-up (see Figure 1). Trait anxiety (STAI-Trait) was associated with long-term anxiety (r = .42, p = .015, R² = .173) and depressive symptoms (r = .42, p = .014, R² = .174), but not with post-traumatic stress symptoms (r = .15, p = .394). Clinician-rated acute anxiety (HAM-A) correlated with long-term anxiety (r = .40, p = .018) and post-traumatic stress symptoms (r = .36, p = .034), showing overall weaker explanatory power (R² ≤ .162, see Figure 2). In direct comparison, self-rated state anxiety demonstrated the strongest and most consistent prognostic value. Discussion Early assessment of acute state anxiety appears to be a practical and effective screening approach in acute cardiology. Self-rated state anxiety outperformed both trait anxiety and clinician-rated interviews in predicting long-term psychological outcomes. As an economical and low-threshold tool, written state anxiety assessment enables early psychological risk stratification during hospitalization. Implementing standardized anxiety screening in routine cardiological care may represent a pragmatic, evidence-based strategy to improve long-term psychosocial outcomes after AMI.Figure 1Figure 2