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The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart disease
Abstract
Objective To (1) report the prognostic association between anxiety disorder subtypes and major adverse cardiac events (MACE), (2) report anxiety disorder prevalence in coronary heart disease (CHD), and (3) report the efficacy of anxiety disorder treatments in CHD.Methods A comprehensive electronic database search was performed in November 2013 for studies reporting anxiety disorder prevalence according to structured interview in CHD samples or MACE, and randomized controlled trials (RCTs) comparing anxiety disorder treatment with placebo or usual care. From 4041 articles 42 samples were selected for extraction (8 for MACE prognosis, 39 for prevalence, no RCTs were eligible).Results Five generalized anxiety disorder (GAD) studies reported 883 MACE events (combined n=2851). There was a non-significant association between GAD and MACE (risk ratio=1.20, 95% CI .86-1.68, P=.28) however the effect size was highly significant in outpatient samples (adjusted hazard ratio=1.94, 95% CI 1.45-2.60, P<.001). No other anxiety disorder subtype was associated with MACE. Prevalence data showed high comorbidity with depression (49.06%; 95% CI 34.28-64.01) and substantial heterogeneity between studies. Panic disorder prevalence was higher in psychiatrist/psychologist raters (9.92% vs. 4.74%) as was GAD (18.45% vs. 13.01%). Panic and GAD estimates were also heterogeneous according to DSM-III-R versus DSM-IV taxonomies.Conclusions The paucity of extant anxiety disorder RCTs, alongside MACE risk for GAD outpatients, should stimulate further anxiety disorder intervention in CHD populations. Research should focus on depression and anxiety, thereby unraveling disorder specific and more generic pathways.
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“Both a clinical diagnosis and subthreshold levels – often undetected – comprise barriers for lifestyle changes, increase risk of non-adherence, refusal or dropout from cardiac rehabilitation (CR), hospitalisation, and premature death [4–6].”
In the citing paper
“Depression is associated with risk of non-adherence to cardiac rehabilitation (CR) and dropout, inadequate risk factor management, poor quality of life (QoL), increased healthcare costs and premature death.”
In the citing paper
“Both a clinical diagnosis and subthreshold levels – often undetected – comprise barriers for lifestyle changes, increase risk of non-adherence, refusal or dropout from cardiac rehabilitation (CR), hospitalisation, and premature death [4–6].”
In the citing paper
“Both a clinical diagnosis and subthreshold levels – often undetected – comprise barriers for lifestyle changes, increase risk of non-adherence, refusal or dropout from cardiac rehabilitation (CR), hospitalisation, and premature death [4–6].”
In the citing paper
“about 50% of CVD patients with GAD are also depressed. 4”
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Todd, B., Foldes‐Busque, G., Way, K. L., Le, K., Alvarenga, M. E., Celano, C. M., Huffman, J. C., & Tully, P. J. (2026) · Systematic Reviews · doi:10.1186/s13643-026-03102-3
Self-citationSila, R., von Känel, R., Attanasio, V., Dörner, M., Guth, L., Zirngast, S., Nager, L., Pazhenkottil, A. P., Menzi, A., König, N., et al. (2026) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2026.112866
Metadata
- Authors
- Tully, P. J., Cosh, S. M., & Baumeister, H.
- Affiliations
- University of Freiburg (DE)
- Universität Ulm (DE)
- Corresponding author
- Tully, Phillip J.
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 77
- Issue
- 6
- Pages
- 439-448
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W1984444522
- Cited by
- 201
- References
- 97
- Citations by year
- 2026: 7 · 2025: 18 · 2024: 18 · 2023: 16 · 2022: 21 · 2021: 24 · 2020: 24 · 2019: 17 · 2018: 20 · 2017: 11 · 2016: 15 · 2015: 10
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Figshare (submittedVersion)
- RUNE (Research UNE) (submittedVersion)
- Funders
- National Health and Medical Research Council of Australia (1053578)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- anxiety disorders, coronary artery disease, generalized anxiety disorder, panic disorder, major adverse cardiac events, comorbid depression, anxiety disorder treatment, psychiatric comorbidity
- MeSH terms
- Anxiety, Anxiety Disorders, Coronary Artery Disease, Coronary Disease, Depression, Humans, Interview, Psychological, Predictive Value of Tests, Prognosis, Risk Factors, Comorbidity, Prevalence, Panic Disorder, Risk Assessment
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