title: The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart disease.
abstract: OBJECTIVE
  To (1) report the prognostic association between anxiety disorder subtypes and major adverse cardiac events (MACE), (2) report anxiety disorder prevalence in coronary heart disease (CHD), and (3) report the efficacy of anxiety disorder treatments in CHD.
  
  
  METHODS
  A comprehensive electronic database search was performed in November 2013 for studies reporting anxiety disorder prevalence according to structured interview in CHD samples or MACE, and randomized controlled trials (RCTs) comparing anxiety disorder treatment with placebo or usual care. From 4041 articles 42 samples were selected for extraction (8 for MACE prognosis, 39 for prevalence, no RCTs were eligible).
  
  
  RESULTS
  Five generalized anxiety disorder (GAD) studies reported 883 MACE events (combined n=2851). There was a non-significant association between GAD and MACE (risk ratio=1.20, 95% CI .86-1.68, P=.28) however the effect size was highly significant in outpatient samples (adjusted hazard ratio=1.94, 95% CI 1.45-2.60, P<.001). No other anxiety disorder subtype was associated with MACE. Prevalence data showed high comorbidity with depression (49.06%; 95% CI 34.28-64.01) and substantial heterogeneity between studies. Panic disorder prevalence was higher in psychiatrist/psychologist raters (9.92% vs. 4.74%) as was GAD (18.45% vs. 13.01%). Panic and GAD estimates were also heterogeneous according to DSM-III-R versus DSM-IV taxonomies.
  
  
  CONCLUSIONS
  The paucity of extant anxiety disorder RCTs, alongside MACE risk for GAD outpatients, should stimulate further anxiety disorder intervention in CHD populations. Research should focus on depression and anxiety, thereby unraveling disorder specific and more generic pathways.
authors.affiliation: Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia; Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany. Electronic address: phillip.tully@adelaide.edu.au.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Tully
authors.affiliation: Clinic of Psychiatry and Psychotherapy II, University of Ulm, Gunzburg, Germany.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Cosh
authors.affiliation: Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Baumeister
mesh_terms: D001007:Anxiety / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D001008:Anxiety Disorders / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000523:psychology; D003327:Coronary Disease / Q000453:epidemiology* / Q000523:psychology*; D003863:Depression / Q000453:epidemiology; D006801:Humans; D007406:Interview, Psychological; D016584:Panic Disorder / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors
keywords: Anxiety disorder; Coronary heart disease; Diagnosis; Meta-analysis; Meta-regression; Prognosis