Relationship of persistent symptoms of anxiety to morbidity and mortality outcomes in patients with coronary heart disease.
OBJECTIVE
To examine the association of symptoms of persistent anxiety with the development of acute cardiac events in patients with coronary heart disease (CHD) followed for 2 years. The prevalence of symptoms of anxiety is high in patients with CHD, but their effect on cardiac events and mortality has not been well characterized.


METHODS
Of 3522 patients with confirmed CHD enrolled, data on symptoms of anxiety were available at two time points in 3048 patients who were then followed up for detection of the composite end point of hospitalization for myocardial infarction, unstable or stable angina, other cardiac causes, or all-cause mortality. A composite anxiety symptoms score composed of baseline and 3-month anxiety data, in which the continuous-level scores were used, was tested using Cox proportional hazards regression model. Groups (persistent anxiety [anxiety at both time points] versus nonanxious [no anxiety at either time point] versus not persistently anxious [anxiety only at one time point]) were also compared.


RESULTS
Symptoms of persistent anxiety, whether considered as a continuous- or categorical-level variable, were associated with shorter time to event. Persistent anxiety remained as an independent predictor of the end point after controlling for multiple variables (persistent anxiety as a summary score [hazard ratio = 1.27, 95% confidence interval = 1.067-1.514] and persistent anxiety as a categorical variable [hazard ratio = 1.52, 95% confidence interval = 1.149-2.015]).


CONCLUSIONS
By measuring anxiety symptoms at more than one time point and controlling for relevant sociodemographic, comorbidity, risk factor, and psychological covariates, we illustrate that symptoms of persistent anxiety are a strong, independent predictor of cardiac event-free survival.
College of Nursing, University of Kentucky, Lexington, KY 40536-0232, USA. dmoser@uky.edu
Debra K
DK
Moser
Sharon
S
McKinley
Barbara
B
Riegel
Lynn V
LV
Doering
Hendrika
H
Meischke
Michele
M
Pelter
Patricia
P
Davidson
Heather
H
Baker
Kathleen
K
Dracup
D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology; D001007:Anxiety / Q000453:epidemiology* / Q000401:mortality; D002908:Chronic Disease; D003327:Coronary Disease / Q000453:epidemiology* / Q000401:mortality; D003863:Depression / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009017:Morbidity; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality; D015995:Prevalence; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013997:Time Factors