Abstract 1980: Anxiety Measured up to two Years Prior to an Acute Coronary Syndrome Event Increases Risk of In-Hospital Complications
Introduction: Anxiety after acute coronary syndrome (ACS) is associated with higher complication rates. To date, most investigators measured anxiety at only one time point and no investigators have examined the effect of anxiety experienced before an ACS event on post-event in-hospital complications. The purpose of this study was to investigate the effects of anxiety measured twice prior to an ACS event on in-hospital complications of patients who subsequently experienced an ACS.
Persistently anxious patients (high anxiety scores at both times) will have more complications than non-anxious (low scores at both times) patients.
Persistent anxiety will be an independent predictor of complications after controlling for factors known to increase risk for complications.
Method: This was a sub-study of a randomized controlled trial of an intervention to decrease delay time for seeking treatment for ACS in patients with known coronary heart disease. Anxiety was measured by the Brief Symptom Inventory at baseline and three months later. Patients were followed for two years or until hospitalized for ACS. Only the 101 patients from the control group (n = 2,700) who developed an ACS were included in this study. Complications were abstracted from medical records after discharge by experienced clinicians blinded to anxiety level and were defined as malignant ventricular dysrhythmias, reinfarction, recurrent ischemia, or death.
Results: Significantly more patients in the persistently anxious group experienced complications than the non-anxious group (30% vs. 9%; p < .05). In a logistic regression, persistent anxiety was an independent predictor of complications after controlling for age, sex, smoking status, peak chest pain, Killip class, beta blocker and anxiolytic use, and history of previous ACS, diabetes, and hypertension. Persistent anxiety placed patients at 7.5 times higher risk for complications.
Conclusion: This was the first study to demonstrate that anxiety measured up to two years prior to an ACS event is predictive of in-hospital complications and associated with higher complication rates.