Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: a meta-analysis.
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.
Roest
Annelieke M
AM
CoRPS Center of Research on Psychology in Somatic Diseases, Tilburg University, 5000 LE Tilburg, Netherlands.
Martens
Elisabeth J
EJ
Denollet
Johan
J
de Jonge
Peter
P
D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D010555:Personality Inventory; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D014481:United States / Q000453:epidemiology