Prognostic association of cardiac anxiety with new cardiac events and mortality following myocardial infarction

Maria H C T Van Beek, Marij Zuidersma, Martijn Lappenschaar, Gheorghe Pop, Annelieke M Roest, Ton van Balkom, Anne E M Speckens, Richard C Oude Voshaar

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BACKGROUND: 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.

AIMS: To evaluate the independent prognostic association of cardiac anxiety with cardiac outcome after myocardial infarction.

METHOD: 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.

RESULTS: 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).

CONCLUSIONS: 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.

Original languageEnglish
Pages (from-to)400-406
Number of pages7
JournalBritish Journal of Psychiatry
Issue number5
Publication statusPublished - Nov 2016

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