Prognostic association of cardiac anxiety with new cardiac events and mortality following myocardial infarction
Open accessAbstract
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 (HR baseline = 1.59, 95% CI 1.04–2.43; HR 4-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 (HR baseline = 1.23, 95% CI 0.99–1.53; HR 4-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.
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In that study, risk was particularly associated with avoidance of exercise assessed 4 months after discharge from the hospital.
“the risk was particularly associated with avoidance of exercise assessed 4 months after discharge from the hospital. 9”
In one study using the Cardiac Anxiety Questionnaire, the CAQ total sum scale was predictive of the prognosis of a major cardiovascular event.
“in one study 9 using the Cardiac anxiety questionnaire (CAQ) to measure heart-focus anxiety, it was found that the CAQ total sum scale was predictive of the prognosis of a major cardiovascular event.”
Heart-focused or cardiac anxiety is a risk factor for adverse outcomes in CVD.
“and a risk factor for adverse outcomes in CVD. 9”
Van Beek et al. advised that cardiac anxiety be explicitly addressed in cardiac rehabilitation and described CBT as a favourable treatment approach.
“Van Beek et al. 9 advised treatment of cardiac anxiety to be explicitly addressed in cardiac rehabilitation and described the use of CBT as favourable treatment approach. 9”
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Additional file 1 of Factors related to fear of movement after acute cardiac hospitalization
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Additional file 2 of Factors related to fear of movement after acute cardiac hospitalization
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- Authors
- Van Beek, M. H. C. T., Zuidersma, M., Lappenschaar, M., Pop, G., Roest, A. M., Van Balkom, A. J. L. M., Speckens, A. E. M., & Oude Voshaar, R. C.
- Affiliations
- University Medical Center Groningen (NL)
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2016-11
- Volume
- 209
- Issue
- 5
- Pages
- 400-406
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2515560870
- Cited by
- 76
- References
- 41
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 6 · 2023: 12 · 2022: 14 · 2021: 8 · 2020: 15 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 2
- FWCI
- 2.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Medical Research Council
- 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 › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- cardiac anxiety, myocardial infarction, major adverse cardiac events, all-cause mortality, cardiac readmission, exercise avoidance, fear, safety-seeking behavior, prognostic factors, depressive symptoms
- MeSH terms
- Aged, Anxiety, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Prognosis
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