title: Prognostic association of cardiac anxiety with new cardiac events and mortality following myocardial infarction.
abstract: General anxiety and depressive symptoms following a myocardial infarction are associated with a worse cardiac prognosis. However, the contribution of specific aspects of anxiety within this context remains unclear.
  
  
  
  To evaluate the independent prognostic association of cardiac anxiety with cardiac outcome after myocardial infarction.
  
  
  
  We administered the Cardiac Anxiety Questionnaire (CAQ) during hospital admission (baseline, n = 193) and 4 months (n = 147/193) after discharge. CAQ subscale scores reflect fear, attention, avoidance and safety-seeking behaviour. Study end-point was a major adverse cardiac event (MACE): readmission for ischemic cardiac disease or all-cause mortality. In Cox regression analysis, we adjusted for age, cardiac disease severity and depressive symptoms.
  
  
  
  The CAQ sum score at baseline and at 4 months significantly predicted a MACE (HRbaseline= 1.59, 95% CI 1.04-2.43; HR4-months= 1.77, 95% CI 1.04-3.02) with a mean follow-up of 4.2 (s.d. = 2.0) years and 4.3 (s.d. = 1.7) years respectively. Analyses of subscale scores revealed that this effect was particularly driven by avoidance (HRbaseline= 1.23, 95% CI 0.99-1.53; HR4-months= 1.77, 95% CI 1.04-1.83).
  
  
  
  Cardiac anxiety, particularly anxiety-related avoidance of exercise, is an important prognostic factor for a MACE in patients after myocardial infarction, independent of cardiac disease severity and depressive symptoms.
authors.affiliation: Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands marleen.vanbeek@radboudumc.nl.
authors.forename: Maria H C T
authors.initials: MH
authors.lastname: Van Beek
authors.affiliation: Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands.
authors.forename: Marij
authors.initials: M
authors.lastname: Zuidersma
authors.affiliation: Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: Lappenschaar
authors.affiliation: Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands.
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Pop
authors.affiliation: Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands.
authors.forename: Annelieke M
authors.initials: AM
authors.lastname: Roest
authors.affiliation: Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands.
authors.forename: Anton J L M
authors.initials: AJ
authors.lastname: Van Balkom
authors.affiliation: Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands.
authors.forename: Anne E M
authors.initials: AE
authors.lastname: Speckens
authors.affiliation: Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands.
authors.forename: Richard C Oude
authors.initials: RC
authors.lastname: Voshaar
mesh_terms: D000368:Aged; D001007:Anxiety / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D011379:Prognosis