Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen, The Netherlands.
J Psychosom Res. 2012 Nov;73(5):362-8. doi: 10.1016/j.jpsychores.2012.09.004. Epub 2012 Sep 28.
Longitudinal elevated depressive symptom scores are associated with a less favorable cardiac outcome. Although anxiety has received less attention, meta-analysis suggests that high baseline levels of general anxiety might worsen cardiac outcome. The objective of this study was to explore the longitudinal course of cardiac anxiety after a myocardial infarction (MI).
The Cardiac Anxiety Questionnaire (CAQ) was administered to 194 patients hospitalized for MI after admission, and one, three, six and twelve months after discharge. Latent class growth analysis (LCGA) was performed to identify groups based on cardiac anxiety course. Between group differences were checked on relevant socio-demographic, cardiac and psychiatric variables.
LCGA identified three groups with stable CAQ levels over time, indicative of high (7.7%), intermediate (45.4%) and low (30.4%) levels of cardiac anxiety, respectively. A fourth group (16.5%) reported high levels of cardiac anxiety that decreased over time. Between group differences were of particular interest for the two subgroups that started high in cardiac anxiety, since these may differentiate patients with spontaneous remission from those who might be in need of treatment. Patients in whom cardiac anxiety persisted were less often employed, had more diabetes mellitus, a history of acute coronary syndrome, depressive symptoms, anxiety and avoidance at baseline and a lower quality of life at follow-up.
This first study addressing cardiac anxiety after an MI identified four trajectories. Future studies should focus on cardiac outcome and treatment strategies for cardiac anxiety in the subgroup with persistent high anxiety levels.
纵向升高的抑郁症状评分与较差的心脏预后相关。尽管焦虑受到的关注较少，但荟萃分析表明，基线时较高的一般焦虑水平可能会使心脏预后恶化。本研究的目的是探讨心肌梗死后心脏焦虑的纵向变化。
在入院后、出院后 1、3、6 和 12 个月，对 194 名因心肌梗住院的患者进行了心脏焦虑问卷（CAQ）的评估。采用潜在类别增长分析（LCGA）根据心脏焦虑的变化来确定患者分组。检查组间相关的社会人口学、心脏和精神变量的差异。
LCGA 确定了三组患者的 CAQ 水平在时间上保持稳定，分别代表高（7.7%）、中（45.4%）和低（30.4%）水平的心脏焦虑。第四组（16.5%）报告了心脏焦虑水平较高，且随着时间的推移逐渐降低。对于开始时心脏焦虑水平较高的两个亚组，组间差异特别有意义，因为这可能会区分那些有自发性缓解的患者和那些可能需要治疗的患者。那些心脏焦虑持续存在的患者，往往较少就业，更多地患有糖尿病、急性冠状动脉综合征病史、抑郁症状、焦虑和回避症状，且在随访时的生活质量更低。
这是第一项针对心肌梗死后心脏焦虑的研究，确定了四种轨迹。未来的研究应关注有持续性高焦虑水平的亚组的心脏预后和心脏焦虑的治疗策略。
