title: Anxiety associations with cardiac symptoms, angiographic disease severity, and healthcare utilization: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation.
abstract: BACKGROUND
  Anxiety is common among patients presenting with suspected coronary artery disease (CAD). In a sample of women with signs and symptoms of ischemia, we examined three anxiety markers as predictors of CAD endpoints including: 1) cardiac symptom indicators; 2) angiographic CAD severity; and 3) healthcare utilization (cardiac hospitalizations and 5-year cardiovascular [CVD] healthcare costs).
  
  
  METHODS
  Participants completed a baseline protocol including coronary angiogram, cardiac symptoms, psychosocial measures and a median 5.9-year follow-up to track hospitalizations. We calculated CVD costs based on cardiac hospitalizations, treatment visits, and CVD medications. Anxiety measures included anxiolytic medication use, Spielberger Trait Anxiety Inventory (STAI) scores, and anxiety disorder treatment history.
  
  
  RESULTS
  The sample numbered 514 women with anxiety measure data and covariates (mean age=57.5 [11.1]). One in five (20.4%) women reported using anxiolytic agents. Anxiety correlated with cardiac symptom indicators (anxiolytic use with nighttime angina and nitroglycerine use; STAI scores and anxiety disorder treatment history with nighttime angina, shortness of breath, and angina frequency). Anxiety disorder treatment history (but not STAI scores or anxiolytics) predicted less severe CAD. Anxiolytic use (but not STAI scores or anxiety disorder treatment history) predicted hospitalizations for chest pain and coronary catheterization (HRs=2.0, 95% CIs=1.1-4.7). Anxiety measures predicted higher 5-year CVD costs (+9.0-42.7%) irrespective of CAD severity.
  
  
  CONCLUSIONS
  Among women with signs and symptoms of myocardial ischemia, anxiety measures predict cardiac endpoints ranging from cardiac symptom severity to healthcare utilization. Based on these findings, anxiety may warrant greater consideration among women with suspected CAD.
authors: VA San Diego Healthcare System, San Diego, CA, United States; University of California, San Diego, CA, United States. Electronic address: Thomas.Rutledge@va.gov.
authors: Thomas
authors: T
authors: Rutledge
authors: Tanya S
authors: TS
authors: Kenkre
authors: Vera
authors: V
authors: Bittner
authors: David S
authors: DS
authors: Krantz
authors: Diane V
authors: DV
authors: Thompson
authors: Sarah E
authors: SE
authors: Linke
authors: Jo-Ann
authors: JA
authors: Eastwood
authors: Wafia
authors: W
authors: Eteiba
authors: Carol E
authors: CE
authors: Cornell
authors: Viola
authors: V
authors: Vaccarino
authors: Carl J
authors: CJ
authors: Pepine
authors: B Delia
authors: BD
authors: Johnson
authors: C Noel
authors: CN
authors: Bairey Merz
mesh_terms: D001007:Anxiety / Q000209:etiology*; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000000981:diagnostic imaging; D054555:National Heart, Lung, and Blood Institute (U.S.); D010342:Patient Acceptance of Health Care; D010555:Personality Inventory; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013577:Syndrome; D013997:Time Factors; D014481:United States
keywords: Anxiety; Cardiovascular disease; Depression; Prospective; Women