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

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% Cl 1.04-2.43; HR4-months= 1.77, 95% Cl 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% Cl 0.99-1.53; HR4-months = 1.77, 95% Cl 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.