Anxiety in Patients with Cardiac Disease

摘要

Anxiety may cause adverse outcomes through physiologic pathways in patients with cardiac disease. The purpose of this dissertation was to investigate anxiety and its correlates in persons with acute myocardial infarction (AMI) and heart failure (HF). The specific aims were to: 1) evaluate whether anxiety levels early after AMI differ across five countries, and to determine whether an interaction between country, and sociodemographic and clinical variables contributes to variations in reporting anxiety; 2) review and analyze the measurement of anxiety for cardiac patients; 3) determine whether heart rate (HR) and blood pressure (BP) are related to anxiety in patients with HF, patients with AMI, and healthy individuals; 4) determine whether the single-item Anxiety Level Index (ALI) is a valid alternative to the State Anxiety Inventory (SAI) or the anxiety subscale of the Brief Symptom Inventory (BSI) for assessing state anxiety in patients with AMI; 5) determine the best predictive model of health status, given sociodemographic, clinical, health perception, and emotional variables for patients with HF; and 6) review neural control of HR, describe heart rate variability (HRV), and summarize research findings regarding HRV of HF patients. Four studies were conducted using existing data from four samples of patients with either AMI or HF. The first was a prospective, comparative study of 912 patients from five countries regarding anxiety after AMI. In the second study, a cross-sectional design was used to examine the relationships of anxiety with and HR and BP in 54 patients with AMI, 32 patients with HF, and 31 healthy individuals. Next, cross- sectional data on three measures of anxiety were analyzed in 243 patients with AMI. Finally, cross-sectional data from 87 patients with HF were evaluated to determine predictors of health status.