Prospective examination of anxiety persistence and its relationship to cardiac symptoms and recurrent cardiac events
Prospective examination of anxiety persistence and its relationship to cardiac symptoms and recurrent cardiac events
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DOI：
10.1159/000080387
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发表时间：
2004-01-01
影响因子：
22.8
通讯作者：
Stewart, DE
中科院分区：
文献类型：
--
作者：
Grace, SL;Abbey, SE;Stewart, DE
背景：目前的研究建立在以前研究的基础上，通过检测持续焦虑对一年后复发事件的影响，证明了焦虑与住院复发的缺血和心律失常事件之间的联系。方法：收集12个冠心病监护病房的913例不稳定型心绞痛(UA)和心肌梗死(MI)患者，分别于发病后6个月和12个月进行随访。测量包括心脏症状学、医疗保健利用情况、初级保健精神障碍评估的焦虑分量表、米德尔塞克斯医院问卷的恐怖焦虑分量表和贝克抑郁问卷。结果：超过1/3的UA和MI患者在发生缺血事件时焦虑升高，50%的焦虑患者这些症状持续了一年。尽管患有焦虑症的参与者报告了更多不典型的心脏症状，但典型心脏症状(如胸痛)的患病率并没有因焦虑而异。在控制了冠状动脉事件的严重程度、家庭收入、性别、糖尿病和吸烟后，以下变量对6个月或1岁时自我报告的复发心脏事件有显著预测作用：年龄、心血管疾病家族史、基线时更多的抑郁症状和6个月时的焦虑。只有38%的焦虑患者被问及这些症状，这表明有效的心理治疗没有得到充分利用。结论：除了抑郁症状的影响(在其他混杂变量中)，非恐惧性焦虑似乎对缺血性冠状动脉事件后的自我报告结果有负面影响。焦虑症状没有得到充分的认识和治疗，必须对二级预防的治疗效果进行检查。版权所有(C)2004 S.Karger AG，巴塞尔。
Background: The current study builds on previous research demonstrating a link between anxiety and inhospital recurrent ischemic and arrhythmic events, by examining the effects of persistent anxiety on recurrent events 1 year later. Methods: 913 patients with unstable angina (UA) and myocardial infarction (MI) from 12 coronary care units were recruited, and follow-up data were collected at 6 and 12 months after the event. Measures included cardiac symptomatology, healthcare utilization, the anxiety subscale of the Primary Care Evaluation of Mental Disorders, the phobic anxiety subscale of the Middlesex Hospital Questionnaire, and the Beck Depression Inventory. Results: Over one third of participants with UA and MI experienced elevated anxiety at the time of the ischemic event, and these symptoms persisted for 1 year in 50% of anxious participants. Although participants with anxiety reported more atypical cardiac symptomatology, the prevalence of typical cardiac symptoms such as chest pain did not differ based on anxiety. After controlling for the severity of the coronary event, family income, sex, diabetes, and smoking, the following variables were significantly predictive of self-reported recurrent cardiac events at 6 months or 1 year: older age, family history of cardiovascular disease, greater depressive symptomatology at baseline, and anxiety at 6 months. Only 38% of anxious patients were asked about such symptoms, indicating underutilization of effective psychotherapeutic treatment. Conclusions: Over and above the effects of depressive symptomatology (among other confounding variables), nonphobic anxiety appears to have a negative effect on self-reported outcome following an ischemic coronary event. Anxiety symptomatology is underrecognized and undertreated, and examination of effects of treatment on secondary prevention must be pursued. Copyright (C) 2004 S. Karger AG, Basel.