Does anxiety after myocardial infarction increase the risk of adverse cardiac outcomes in patients with MI?
Post-MI anxiety is associated with a 36% increased risk of adverse cardiac outcomes, suggesting a need for further research on its independent prognostic value.
Objective: To assess the association of anxiety after myocardial infarction (MI) with cardiac prognosis. Methods: A meta-analysis of references derived from MEDLINE, EMBASE, and PSYCINFO (1975–March 2009) was performed without language restrictions. End point was cardiac outcome defined as all-cause mortality, cardiac mortality, and cardiac events. The authors selected prospective studies with at least 6 months follow-up, and anxiety had to be assessed within 3 months after MI with reliable and valid instruments. Results: Twelve papers met selection criteria. These studies described follow-up (on average, 2.6 years) of 5750 patients with MI. Anxious patients were at risk of adverse events (odds ratio (OR) fixed, 1.36; 95% confidence interval (CI), 1.18–1.56; p < .001). Anxiety was also specifically associated with all-cause mortality (OR fixed, 1.47; 95% CI, 1.02–2.13; p = .04), cardiac mortality (OR fixed, 1.23; 95% CI, 1.03–1.47; p = .02), and new cardiac events (OR fixed, 1.71; 95% CI, 1.31–2.23; p < .001). Conclusions: Post-MI anxiety is associated with a 36% increased risk of adverse cardiac outcomes in bivariate analyses. Because the existing literature is small and contains several limitations, more research is needed to evaluate the association of anxiety and prognosis in patients with MI and to assess the extent to which this association is independent of clinical variables, such as disease severity, and other psychological variables, especially depression. BMI = body mass index; CABG = coronary artery bypass graft; CHD = coronary heart disease; CI = confidence interval; CBAHF = Cognitive Behavioral Assessment Hospital Form; ENRICHD = Enhancing Recovery in Coronary Heart Disease Patients; FEM = fixed effects model; GAD = generalized anxiety disorder; HADS = Hospital Anxiety and Depression Scale; HR = hazard ratio; LVEF = left ventricular ejection fraction; MI = myocardial infarction; MIND-IT = Myocardial Infarction and Depression Intervention Trial; NA = not available; OR = odds ratio; REM = random effects model; STAI = State Trait Anxiety Inventory; STPI = State Trait Personality Inventory; UA = unstable angina.
Roest et al. (2010) studied this question.