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The Cardiac Anxiety Questionnaire: development and preliminary validity
Abstract
Heart-focused anxiety (HFA) is the fear of cardiac-related stimuli and sensations because of their perceived negative consequences. Although HFA is common to a wide variety of persons who experience chest pain and distress, it often is unrecognized and misdiagnosed, particularly in cardiology and emergency room patients without and with heart disease. To address these concerns, this article reports on the development and preliminary psychometric evaluation of the Cardiac Anxiety Questionnaire (CAQ) designed to measure HFA. In Study 1, 188 cardiology patients completed the CAQ. Item and factor analyses indicated a three-factor solution pertaining to heart-related fear, avoidance, and attention. Reliability analysis of the 18-item CAQ revealed good internal consistency of the total and subscale scores. In Study 2, 42 patients completed the CAQ and several other anxiety-related questionnaires to assess its convergent and divergent properties. Although preliminary validity results are promising, further psychometric study is necessary to cross-validate the CAQ, examine its test-retest reliability, and confirm the stability of the factor structure. Taken together, the CAQ appears to assess HFA, and may therefore be a useful instrument for identifying patients with elevated HFA without and with heart disease.
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“CAQ has shown reliability and validity among cardiac patients [25].”
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“The CAQ measures heart-focused anxiety, as this may be a more specific form of anxiety relevant to heart patients (Eifert et al., 2000;van Beek et al., 2012).”
From Postponement of elective cardiac surgery: A prospective observational analysis of anxiety, depression, social support and clinical complications. (2023) · cites this paper as Eifert et al., 2000
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“Eifert, Thompson, Zvolensky, Edwards, Frazer et al., 2000 ) is an 18-item, self-report questionnaire that assesses heart-focused anxiety related to a fear of cardiac stimuli or sensations.”
BackgroundInfluentialQuality of life in patients with type 2 diabetes mellitus: a cross-sectional study
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“The CAQ consists of three subscales: fear, avoidance, and heart-focused attention [15].”
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“…Cardiac Anxiety Questionnaire [degree and course of heart-focused anxiety (HFA) in patients with cardiac diseases before and after cardiac surgery] 21 ; Patient Health Questionnaire: PHQ-D 22 ; Short Form 36 (SF-36) questionnaire 23 ; Maastricht questionnaire 24 ; MMPI: Minne-sota Multiphasic…”
Leadless Pacemakers: The “Leading Edge” of Quality of Life in Cardiac Electrophysiology
Sears, S. F., Jordan, E. W., Hashmath, Z., Sargeant, M. M., Catanzaro, J., Nekkanti, R., & Shantha, G. P. S. (2025) · Current Cardiology Reports · doi:10.1007/s11886-025-02228-5 · Cited by 3
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Kiwanuka, F. (2019) · Scientific Journal of Research & Reviews · doi:10.33552/sjrr.2019.01.000514 · Cited by 4
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BackgroundPsychological Treatment Considerations in Medical Comorbidity
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“The items on this questionnaire are listed by a range of psychologists and cardiologists who have experience in managing psychiatric and cardiac patients.(13,15) Eighteen items were selected by consensus, which constitutes the face validity of the scale; both positive and negative items were selected.”
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“…Alcohol Use Disorders Identification Test [16], the 9-item Patient Health Questionnaire (PHQ-9) measuring depressive symptoms [17], the Atrial Fibrillation Effects on Quality of Life (AFEQT) questionnaire adapted for PVCs (primary outcome measure), and the Cardiac Anxiety Questionnaire (CAQ) [18].”
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Webster, R. (2012) · White Rose eTheses Online (University of Leeds, The University of Sheffield, University of York) · Cited by 3
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“30 The scale consists of 18 items, rated on a 5-point Likert scale, 0 to 4 (never, rarely, sometimes, often, and always), comprising the 3 factors fear (8 items), avoidance (5 items), and attention (5 items).”
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InfluentialSelf-citationJohnsson, A., Ljótsson, B., Braunschweig, F., Mellbin, L., & Särnholm, J. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-106473 · Cited by 1
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InfluentialWorkaholism, heart anxiety, and their effects on work-focused well-being and turnover intentions
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InfluentialThe relationship between cardiac anxiety and hostility in panic attack patients
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Exercise in Panic Disorder: Implications for Disorder Maintenance, Treatment and Physical Health
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Craft, J. M. (2011) · IRL - University of Missouri, St. Louis (University of Missouri–St. Louis) · Cited by 1
Ritzka, D., Petzold, C., Wäßnig, N. K., Schmalbach, B., & Petrowski, K. (2020) · Psychology, Health & Medicine · doi:10.1080/13548506.2019.1612077 · Cited by 1
“Anxiety Questionnaire CAQ (Eifert et al., 2000) and measures heart-focused anxiety.”
BackgroundFactors Associated with Medication Adherence in Coronary Artery Patients
Rad, S. M., Moghadamnia, M. T., Leili, E. K., & Javadi‐Pashaki, N. (2022) · Journal of Holistic Nursing and Midwifery · doi:10.32598/jhnm.32.4.2270 · Cited by 1
“The range of total scores is between 0 and 72, and higher scores indicate more cardiac anxiety [19, 23].”
BackgroundRoohafza, H., Saneian, P., Feizi, A., Khani, A., Yavari, N., Bagherieh, S., Shafiei, M., Masoumi, G., & Sadeghi, M. (2022) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-022-09916-2 · Cited by 1
Hamel, S., Denis, I., Turcotte, S., Fleet, R. P., Archambault, P. M., Dionne, C. E., & Foldes‐Busque, G. (2023) · Journal of the Academy of Consultation-Liaison Psychiatry · doi:10.1016/j.jaclp.2023.04.007 · Cited by 1
Tully, P. J., & Cosh, S. (2023) · doi:10.1093/oso/9780197564295.003.0012 · Cited by 1
Hill, B., Grubic, N., Liblik, K., & Johri, A. M. (2023) · CJC Open · doi:10.1016/j.cjco.2023.11.002 · Cited by 1
“10 We hypothesize that this could be attributable to patients with HCM highly involved in care being more aware of the risks of their condition (ie, SCD) and the precipitating factors of cardiac events (ie, dyspnea, tachycardia, myocardial ischemia), although because of the limitations of our…”
BackgroundSex Differences in Physical Activity Levels and Sitting Time in Patients With Atrial Fibrillation
Marçal, I. R., Vidal‐Almela, S., Blanchard, C., Prince, S. A., Way, K. L., & Reed, J. L. (2024) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0000000000000867 · Cited by 1
“26,27 Two questions assessed task self-efficacy (eg, “How confident do you feel performing moderate-intensity PA?”).”
BackgroundGiacomo, D. D., Sciarra, L., Fusco, L., Robles, A. G., Pernat, A., & Romano, S. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-082459 · Cited by 1
Cappadona, I., Anselmo, A., Cardile, D., Micali, G., Giambò, F. M., Speciale, F., Costanzo, D., D'Aleo, P., Duca, A., Bramanti, A., et al. (2025) · Medical Sciences · doi:10.3390/medsci13030105 · Cited by 1
Mourad, G. (2015) · Linköping University medical dissertations · doi:10.3384/diss.diva-122592 · Cited by 1
Distinguishing Cardiac from Psychological Somatic Symptoms
Rodolico, A., & Mineo, L. (2019) · Springer eBooks · doi:10.1007/978-3-319-90305-7_16-1 · Cited by 1
Herzangst in der psychosomatisch-psychokardiologischen Therapie
Weber, C., & Neiss, P. (2021) · PiD - Psychotherapie im Dialog · doi:10.1055/a-1215-0773 · Cited by 1
“[2] Eifert GH, Thompson RN, Zvolensky MJ et al.”
BackgroundInfluentialDistinguishing Cardiac from Psychological Somatic Symptoms
Rodolico, A., & Mineo, L. (2020) · Springer eBooks · doi:10.1007/978-3-030-28008-6_16 · Cited by 1
Öberg, S., Johansson, L., Georgsson, M., Sandberg, J., & Broström, A. (2023) · Nursing Open · doi:10.1002/nop2.1717 · Cited by 1
“A higher score indicates greater heart-focused anxiety (Eifert et al., 2000).”
BackgroundSheehan, A. (2012) · Figshare · doi:10.25419/rcsi.10805186 · Cited by 1
Anxiety-Driven Cardiopulmonary Complaints during COVID-19 Pandemic OutbreakPreprint
Koren, O., Rajab, S. A., Barbour, M., Shachar, M., Shahar, A., Zubidat, K., Slim, W., Igbariya, D., Rozner, E., Turgeman, Y., et al. (2021) · Preprints.org · doi:10.20944/preprints202102.0481.v1 · Cited by 1
“It was also found to be an accurate screening tool for three other common anxiety disorders - panic disorder (sensitivity 74%, specificity 81%), social anxiety disorder (sensitivity 72%, specificity 80%), and posttraumatic stress disorder (sensitivity 66%, specificity 81%) [14-16].”
BackgroundAppendix A: Selected Screening Tools and Research Instruments
Pickett, S. M., & Ravindranath, D. (2011) · Wiley eBooks · doi:10.1002/9780470975138.app1
Sardinha, A., Nardi, A. E., Gil, C., de Araújo, S., Ferreira, M. C., & Eifert, G. H. (2013)
Self-citationAkman, I., Bielen, R., Brümmer, H., Kudrjaschow, E., Tschentscher, S., Dohndorf, O., Krumm, H., Hoffmann, J., Workowski, A., & Willemsen, D. (2014) · International Conference on Health Informatics · doi:10.5220/0004797300780089
“Reduction of fears: As it is generally known, patients with a cardiac disease commonly have to cope with fears (Eifert et al., 2000).”
BackgroundPre-habilitation program for elective coronary artery bypass graft surgery patients: a pilot project
Kehler, D. S. (2012) · Mspace (University of Manitoba)
Anxiety trends in patients awaiting invasive cardiac procedures in the outpatient preprocedural unit
Shajimon, B., & Dreher, H. M. (2013) · iDEA - Drexel University Institutional Repository · doi:10.17918/etd-6142
Cardiac Anxiety - When the heart is (thought to be) in danger-
van Beek, M. H. C. T. (2016) · Radboud Repository (Radboud University)
Sardinha, A., Gil, C., de Araújo, S., & Nardi, A. E. (2011)
Metadata
- Authors
- Eifert, G. H., Thompson, R. N., Zvolensky, M. J., Edwards, K., Frazer, N. L., Haddad, J. W., & Davig, J.
- Affiliations
- West Virginia University (US)
- Corresponding author
- Eifert, Georg H
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2000-10
- Volume
- 38
- Issue
- 10
- Pages
- 1039-1053
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2015235226
- Cited by
- 349
- References
- 44
- Citations by year
- 2026: 24 · 2025: 28 · 2024: 25 · 2023: 23 · 2022: 43 · 2021: 23 · 2020: 27 · 2019: 12 · 2018: 15 · 2017: 9 · 2016: 15 · 2015: 12 · 2014: 10 · 2013: 11 · 2012: 12
- FWCI
- 4.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- psychometric development, questionnaire validation, avoidance, attention, chest pain, cardiac patients, anxiety assessment, factor structure
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