title: Inverse correlation between cardiac injury and cardiac anxiety: a potential role for communication.
abstract: OBJECTIVE
  General anxiety in cardiac patients is associated with worsened cardiac course. An acute coronary syndrome (ACS) might evoke specific cardiac anxiety. We explored the characteristics associated with cardiac anxiety in ACS patients.
  
  
  METHODS
  We assessed cardiac anxiety in 237 patients admitted with ACS using the Cardiac Anxiety Questionnaire and gathered information on sociodemographic, psychological, and cardiac disease characteristics. Univariate, multivariate logistic, and linear regression analyses were used to determine which characteristics were associated with cardiac anxiety.
  
  
  RESULTS
  Cardiac anxiety was not associated with sociodemographic variables. More severe cardiac injury, as indicated by ST-elevated myocardial infarction and troponin level, was associated with less cardiac anxiety. Psychological variables (depressive symptoms, agoraphobic cognitions, avoidance behavior) were associated with more cardiac anxiety.
  
  
  CONCLUSIONS
  Cardiac anxiety in ACS patients is associated with more psychological distress but lower severity of cardiac injury as indicated by ST-elevated myocardial infarction and troponin level. Two explanations seem likely for this latter finding. First, anxious persons might seek help earlier, thus being diagnosed more often with minor cardiac pathology. Second, cardiac anxiety might partly be caused by diagnostic uncertainty. Future research should focus on communication strategies to reassure patients more efficiently.
authors.affiliation: Maria H.C.T. van Beek, MD Psychiatrist, Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen, the Netherlands. Richard C. Oude Voshaar, MD, PhD Senior researcher at the Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen, and Professor, Old Age Psychiatry at University Center of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands. Femke M. van Deelen, MD Medical Doctor, Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen, the Netherlands. Anton J.L.M. van Balkom, MD, PhD Professor of Psychiatry, Department of Psychiatry and EMGO+ Institute, VU University Medical Centre and GGZinGeest, Amsterdam, the Netherlands. Gheorghe Pop, MD, PhD Cardiologist, Radboud University Nijmegen Medical Centre, Department of Cardiology, Nijmegen, the Netherlands. Anne E.M. Speckens, MD, PhD Professor of Psychiatry, Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen, the Netherlands.
authors.forename: Maria H C T
authors.initials: MH
authors.lastname: van Beek
authors.forename: Richard C
authors.initials: RC
authors.lastname: Oude Voshaar
authors.forename: Femke M
authors.initials: FM
authors.lastname: van Deelen
authors.forename: Anton J L M
authors.initials: AJ
authors.lastname: van Balkom
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Pop
authors.forename: Anne E M
authors.initials: AE
authors.lastname: Speckens
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology*; D000368:Aged; D001007:Anxiety / Q000453:epidemiology*; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011379:Prognosis; D013315:Stress, Psychological / Q000453:epidemiology; D011795:Surveys and Questionnaires