Abstract 2424: Persistent Anxiety Predicts Acute Coronary Syndrome Events in Patients with Coronary Heart Disease
Background: Psychosocial factors affect morbidity and mortality in CAD. Despite its high prevalence in CAD, the effect of anxiety on cardiac events has not been well characterized and current evidence is equivocal. A main reason for conflicting findings is measurement of anxiety at only one time point.
Purpose: To examine the impact of persistent anxiety on development of acute cardiac events (including cardiac mortality) in CAD patients followed for 3 years.
Methods: Participants in a multicenter, randomized trial of an intervention to decrease patient delay in seeking treatment for CAD symptoms who had baseline and 3 month anxiety data were studied (n=3048). Anxiety was measured using the anxiety subscale-Brief Symptom Inventory. Cardiac events were assessed using interview, hospital databases, and death records. The combined endpoint was hospitalization for myocardial infarction, unstable or stable angina or mortality. Groups (persistent anxiety [anxiety at both time points] vs all others [no anxiety at either time point or anxiety only at one time point]) were compared using Kaplan-Meier survival curves and log rank test.
Results: Persistent anxiety was associated with shorter time to adverse outcome (Figure⇓, p=.001). In Cox regression, persistent anxiety remained a predictor of adverse outcome after controlling for age, gender, previous AMI, diabetes, smoking, group assignment, education, income, body mass index, sedentary life-style and marital status (odds ratio 1.3 [1.04 –1.6], p=.02).
Conclusion: By measuring anxiety at more than one time point, these data illustrate that persistent anxiety is a strong, independent predictor of event-free survival.