Does Anxiety Affect Survival in Patients with Coronary Heart Disease?

Hans-Christian Deter; Wolfgang Albert; Cora Weber; Melanie Merswolken; Kristina Orth-Gomér; Christoph Herrmann-Lingen; Anna-Sophia Grün

doi:10.3390/jcm12062098

Does Anxiety Affect Survival in Patients with Coronary Heart Disease?

J Clin Med. 2023 Mar 7;12(6):2098. doi: 10.3390/jcm12062098.

Authors

Hans-Christian Deter^{1

2}, Wolfgang Albert³, Cora Weber¹, Melanie Merswolken¹, Kristina Orth-Gomér⁴, Christoph Herrmann-Lingen^{5

6}, Anna-Sophia Grün¹

Affiliations

¹ Medical Clinic, Division of Psychosomatic Medicine, Charité Universitätsmedizin, Campus Benjamin Franklin, 12203 Berlin, Germany.
² German Center for Cardiovascular Research, Partner Site Berlin, 10785 Berlin, Germany.
³ Psychosomatics, Medical Heart Center of Charite and German Heart Institute Berlin, Institute of Cardiothoracic and Vascular Surgery, 13353 Berlin, Germany.
⁴ Department of Clinical Neuroscience, Karolinska Institute, 171 77 Stockholm, Sweden.
⁵ Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, 37075 Gottingen, Germany.
⁶ German Center for Cardiovascular Research, Partner Site Göttingen, 37075 Göttingen, Germany.

Abstract

Introduction: Behavioral and physiological risk factors worsen the prognosis of coronary heart disease (CHD). Anxiety is known to be a psychological predictor of CHD. In this study, we investigated whether this factor is associated with all-cause mortality in CHD patients in the long term.

Methods: We studied 180 patients (mean age 60.6 SD 9.2 years, 26% women) with CHD from the Berlin Anxiety Trial (BAT) and the Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease (SPIRR-CAD) study. Their cardiac and psychological risk profile was represented by standardized procedures, including the Hospital Anxiety and Depression Scale (HADS) questionnaire. Mortality outcomes were assessed using a community-based registry.

Results: Of 180 patients, we obtained information on all-cause mortality in 175 (96.7%) after a mean follow-up of 12.2 years (range 10.4-16.6 years). Of all participants, 54.4% had prior myocardial infarction, 95.3% had percutaneous transluminal coronary angioplasty and 22.2% had prior coronary artery bypass graft. Most of the patients (98.4%) had New York Heart Association class I and II, 25.6% had diabetes and 38.2% were smokers. Patients had a mean HADS anxiety score of 9.7 SD 4.1 at study entrance. We found the highest HADS anxiety quartile all-cause mortality in 14%, 30.2% in the middle quartiles and 58.7% in the lowest quartile (chi² 20.8, p = 0.001). Related to psychological mechanisms, a low level of anxiety, seemed to be a significant predictor of all-cause mortality. We found no advantage for patients who had received psychosocial therapy in terms of survival.

Conclusion: These first data confirmed our hypothesis about the association of psychological risk factors with the long-term outcome of CAD patients. Future studies will clarify whether the severity of disease, age or a particular type of coping or denial mechanism are associated with the presented outcome in low-anxious patients.

Keywords: 12-year follow-up; anxiety; coronary heart disease; psychological intervention.

Grants and funding

The SPIRR-CAD trial was funded by the German Research Foundation (DFG) #HE3115/10-1; PI Christoph Herrmann-Lingen, Göttingen, Christian Albus, Köln (SPIRR-CAD, NCT00705965).