Anxiety associations with cardiac symptoms, angiographic disease severity, and healthcare utilization: The NHLBI-sponsored Women's Ischemia Syndrome Evaluation

详细信息    查看全文

• 作者：Thomas Rutledge ; Tanya S. Kenkre ; Vera Bittner ; David S. Krantz ; Diane V. Thompson ; Sarah E. Linke ; Jo-Ann Eastwood ; Wafia Eteiba ; Carol E. Cornell ; Viola Vaccarino ; Carl J. Pepine ; B. Delia Johnson ; C. Noel Bairey Merz
• 关键词：Cardiovascular disease ; Women ; Prospective ; Anxiety ; Depression
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：3 October, 2013
• 年：2013
• 卷：168
• 期：3
• 页码：2335-2340
• 全文大小：364 K

文摘

Background

Anxiety is common among patients presenting with suspected coronary artery disease (CAD). In a sample of women with signs and symptoms of ischemia, we examined three anxiety markers as predictors of CAD endpoints including: 1) cardiac symptom indicators; 2) angiographic CAD severity; and 3) healthcare utilization (cardiac hospitalizations and 5-year cardiovascular [CVD] healthcare costs).

Methods

Participants completed a baseline protocol including coronary angiogram, cardiac symptoms, psychosocial measures and a median 5.9-year follow-up to track hospitalizations. We calculated CVD costs based on cardiac hospitalizations, treatment visits, and CVD medications. Anxiety measures included anxiolytic medication use, Spielberger Trait Anxiety Inventory (STAI) scores, and anxiety disorder treatment history.

Results

The sample numbered 514 women with anxiety measure data and covariates (mean age = 57.5 [11.1]). One in five (20.4 % ) women reported using anxiolytic agents. Anxiety correlated with cardiac symptom indicators (anxiolytic use with nighttime angina and nitroglycerine use; STAI scores and anxiety disorder treatment history with nighttime angina, shortness of breath, and angina frequency). Anxiety disorder treatment history (but not STAI scores or anxiolytics) predicted less severe CAD. Anxiolytic use (but not STAI scores or anxiety disorder treatment history) predicted hospitalizations for chest pain and coronary catheterization (HRs = 2.0, 95 % CIs = 1.1-4.7). Anxiety measures predicted higher 5-year CVD costs (+ 9.0-42.7 % ) irrespective of CAD severity.

Conclusions

Among women with signs and symptoms of myocardial ischemia, anxiety measures predict cardiac endpoints ranging from cardiac symptom severity to healthcare utilization. Based on these findings, anxiety may warrant greater consideration among women with suspected CAD.