title: Complications after acute coronary syndrome are reduced by perceived control of cardiac illness.
abstract: OBJECTIVE
  To investigate the relationship between anxiety, perceived control and rate of in-hospital complications after acute coronary syndrome.
  
  
  BACKGROUND
  Anxiety may be associated with higher risk of complications following acute myocardial infarction; perceived control may moderate this relationship.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Patients enrolled in a trial investigating delay in seeking treatment for acute coronary syndrome had anxiety measured at enrolment and 3 months using the Brief Symptom Inventory anxiety subscale. The acute coronary syndrome hospital presentations investigated occurred between 2001-2006. Patients with anxiety scores greater than the population norm at both time points were categorized as persistently anxious. Perceived control was measured at enrolment using the control attitudes scale-revised. Data were collected from the medical record on in-hospital complications in patients presenting with acute coronary syndrome within 2 years of enrolment. Chi-square and t-tests were used for univariate analyses and multiple logistic regression to identify independent predictors of complications.
  
  
  RESULTS
  Patients (n = 171) were 64% men with mean age 69 years. Ischaemic or arrhythmic complications occurred in 26 patients (15%) with no difference in complication rates between those persistently anxious and others. Important univariate predictors of in-hospital complications were lower perceived control, diagnosis of acute myocardial infarction, heart failure and higher pulse rate on admission. Low perceived control and diagnosis of acute myocardial infarction were independent predictors of in-hospital complications in the multiple logistic regression.
  
  
  CONCLUSIONS
  Perceived control, but not persistent anxiety, prior to acute coronary syndrome was an important predictor of in-hospital complications after acute coronary syndrome. Interventions to increase cardiac patients' perceived control of their cardiac illness may reduce in-hospital complications after acute coronary syndrome.
authors.affiliation: Critical Care Nursing Professorial Unit, University of Technology, Sydney, Australia. sharon.mckinley@uts.edu.au
authors.forename: Sharon
authors.initials: S
authors.lastname: McKinley
authors.forename: Mary
authors.initials: M
authors.lastname: Fien
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
authors.forename: Hendrika
authors.initials: H
authors.lastname: Meischke
authors.forename: Mohannad E
authors.initials: ME
authors.lastname: Aburuz
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000451:nursing / Q000523:psychology*; D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology; D001007:Anxiety / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007389:Internal-External Control; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D009517:New South Wales / Q000453:epidemiology; D009520:New Zealand / Q000453:epidemiology; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000453:epidemiology; D012008:Recurrence; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology