Impact of anxiety on the post-discharge outcomes of patients discharged from the hospital after an acute coronary syndrome

• Published in: International journal of cardiology Vol. 278; pp. 28 - 33
• Main Authors: Tran, Hoang, Byatt, Nancy, Erskine, Nathaniel, Lessard, Darleen, Devereaux, Randolph S., Saczynski, Jane, Kiefe, Catarina, Goldberg, Robert
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-03-2019
• Subjects: Acute coronary syndrome; Anxiety; Mortality; Rehospitalization; Anxiety; Rehospitalization; Acute coronary syndrome; Mortality
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2018.09.068

Symptoms of anxiety are highly prevalent among survivors of an acute coronary syndrome (ACS), but do not necessarily indicate an anxiety disorder. The extent to which symptoms of anxiety or a diagnosis of this condition impacts hospital readmission and post-discharge mortality among patients with an ACS remains unclear.
We used data from 1909 patients discharged from six hospitals in Massachusetts and Georgia after an ACS. Moderate/severe symptoms of anxiety were defined based on responses to a Generalized Anxiety Disorder questionnaire during the patient's index hospitalization. The diagnosis of an anxiety disorder was based on review of hospital medical records. Multivariable adjusted Poisson regression and Cox proportional-hazards models were used to estimate the risk of 30-day hospital readmissions and 2-year total mortality.
The mean age of the study population was 61 years, two thirds were men, and 78% were non-Hispanic whites. In this population, 10.4% had a documented diagnosis of an anxiety disorder, 18.8% had moderate/severe symptoms of anxiety, and 70.8% had neither a diagnosis nor symptoms of anxiety. Neither a diagnosis of an anxiety disorder nor symptoms of anxiety were associated with 30-day all-cause or cardiovascular-related rehospitalizations. Patients with an anxiety disorder (multivariable adjusted HR = 1.95, 95%CI = 1.11–3.42) were at greatest risk for dying during the 2-year follow-up period.
We identified patients with an anxiety disorder as being at greater risk for dying after hospital discharge for an ACS. Interventions may be more appropriately targeted to those with a history of, rather than acute symptoms of, anxiety.
•Symptoms of anxiety are prevalent among hospital survivors of an acute coronary syndrome (ACS)•Anxiety symptoms or established anxiety disorder were not associated with 30 day all-cause or CVD-related rehospitalization•Established anxiety disorder, but not anxiety symptoms, were associated with higher mortality risk over 2 years of follow-up