title: Role of cardiac disease severity in the predictive value of anxiety for all-cause mortality.
abstract: OBJECTIVE
  To identify moderators that influence the relationship of anxiety and long-term prognosis in patients with coronary heart disease (CHD). It has been an ongoing source of controversy what the long-term effects of anxiety are on mortality in patients with CHD, suggesting heterogeneity in prognostic parameters.
  
  
  METHODS
  The prognostic role of anxiety was examined in a large sample of patients (n = 4864), who completed the Hospital Anxiety and Depression Scale (HADS) before routine exercise testing. At 5-year follow-up, survival data were obtained and mortality was assessed by means of Cox proportional hazard models.
  
  
  RESULTS
  In the whole sample, higher anxiety scores were associated with reduced mortality (adjusted hazard ratio [HR] = 0.77; 95% confidence interval (CI) = 0.67-0.88; p < .001). Similar findings were obtained in the subgroup of patients without clinical evidence of CHD (n = 2514; HR = 0.74; 95% CI = 0.59-0.93; p = .01). In patients with CHD but without a history of myocardial infarction (MI), anxiety remained a significant predictor of better survival (HR = 0.70; 95% CI = 0.51-0.97; p = .031). In post-MI patients, no beneficial effect of anxiety was observed. In the subgroup of post-MI patients with reduced ejection fraction, anxiety was associated with increased mortality (n = 536; HR = 1.32; CI = 1.07-1.65; p = .011).
  
  
  CONCLUSIONS
  Anxiety exhibits opposite effects on survival in patients with stable cardiac conditions versus post-MI patients with reduced systolic left ventricular (LV) function. We found that a noninvasive physical risk index and the degree of LV dysfunction seem to modulate the prognostic significance of anxiety. These data suggest that the combined screening for anxiety symptoms and LV dysfunction may improve risk stratification in patients with CHD.
authors.affiliation: Department of Cardiology, University of Marburg, Marburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Meyer
authors.forename: Ullrich
authors.initials: U
authors.lastname: Buss
authors.forename: Christoph
authors.initials: C
authors.lastname: Herrmann-Lingen
mesh_terms: D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D002423:Cause of Death; D015897:Comorbidity; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D004562:Electrocardiography; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology; D010555:Personality Inventory; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology