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Anxiety associations with cardiac symptoms, angiographic disease severity, and healthcare utilization: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation.
Int J Cardiol 2013; 168(3):2335-40IJ

Abstract

BACKGROUND

Anxiety is common among patients presenting with suspected coronary artery disease (CAD). In a sample of women with signs and symptoms of ischemia, we examined three anxiety markers as predictors of CAD endpoints including: 1) cardiac symptom indicators; 2) angiographic CAD severity; and 3) healthcare utilization (cardiac hospitalizations and 5-year cardiovascular [CVD] healthcare costs).

METHODS

Participants completed a baseline protocol including coronary angiogram, cardiac symptoms, psychosocial measures and a median 5.9-year follow-up to track hospitalizations. We calculated CVD costs based on cardiac hospitalizations, treatment visits, and CVD medications. Anxiety measures included anxiolytic medication use, Spielberger Trait Anxiety Inventory (STAI) scores, and anxiety disorder treatment history.

RESULTS

The sample numbered 514 women with anxiety measure data and covariates (mean age=57.5 [11.1]). One in five (20.4%) women reported using anxiolytic agents. Anxiety correlated with cardiac symptom indicators (anxiolytic use with nighttime angina and nitroglycerine use; STAI scores and anxiety disorder treatment history with nighttime angina, shortness of breath, and angina frequency). Anxiety disorder treatment history (but not STAI scores or anxiolytics) predicted less severe CAD. Anxiolytic use (but not STAI scores or anxiety disorder treatment history) predicted hospitalizations for chest pain and coronary catheterization (HRs=2.0, 95% CIs=1.1-4.7). Anxiety measures predicted higher 5-year CVD costs (+9.0-42.7%) irrespective of CAD severity.

CONCLUSIONS

Among women with signs and symptoms of myocardial ischemia, anxiety measures predict cardiac endpoints ranging from cardiac symptom severity to healthcare utilization. Based on these findings, anxiety may warrant greater consideration among women with suspected CAD.

Authors+Show Affiliations

VA San Diego Healthcare System, San Diego, CA, United States; University of California, San Diego, CA, United States. Electronic address: Thomas.Rutledge@va.gov.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23410495

Citation

Rutledge, Thomas, et al. "Anxiety Associations With Cardiac Symptoms, Angiographic Disease Severity, and Healthcare Utilization: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation." International Journal of Cardiology, vol. 168, no. 3, 2013, pp. 2335-40.
Rutledge T, Kenkre TS, Bittner V, et al. Anxiety associations with cardiac symptoms, angiographic disease severity, and healthcare utilization: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation. Int J Cardiol. 2013;168(3):2335-40.
Rutledge, T., Kenkre, T. S., Bittner, V., Krantz, D. S., Thompson, D. V., Linke, S. E., ... Bairey Merz, C. N. (2013). Anxiety associations with cardiac symptoms, angiographic disease severity, and healthcare utilization: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation. International Journal of Cardiology, 168(3), pp. 2335-40. doi:10.1016/j.ijcard.2013.01.036.
Rutledge T, et al. Anxiety Associations With Cardiac Symptoms, Angiographic Disease Severity, and Healthcare Utilization: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation. Int J Cardiol. 2013 Oct 3;168(3):2335-40. PubMed PMID: 23410495.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anxiety associations with cardiac symptoms, angiographic disease severity, and healthcare utilization: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation. AU - Rutledge,Thomas, AU - Kenkre,Tanya S, AU - Bittner,Vera, AU - Krantz,David S, AU - Thompson,Diane V, AU - Linke,Sarah E, AU - Eastwood,Jo-Ann, AU - Eteiba,Wafia, AU - Cornell,Carol E, AU - Vaccarino,Viola, AU - Pepine,Carl J, AU - Johnson,B Delia, AU - Bairey Merz,C Noel, Y1 - 2013/02/12/ PY - 2012/08/17/received PY - 2012/11/21/revised PY - 2013/01/18/accepted PY - 2013/2/16/entrez PY - 2013/2/16/pubmed PY - 2014/12/17/medline KW - Anxiety KW - Cardiovascular disease KW - Depression KW - Prospective KW - Women SP - 2335 EP - 40 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 168 IS - 3 N2 - BACKGROUND: Anxiety is common among patients presenting with suspected coronary artery disease (CAD). In a sample of women with signs and symptoms of ischemia, we examined three anxiety markers as predictors of CAD endpoints including: 1) cardiac symptom indicators; 2) angiographic CAD severity; and 3) healthcare utilization (cardiac hospitalizations and 5-year cardiovascular [CVD] healthcare costs). METHODS: Participants completed a baseline protocol including coronary angiogram, cardiac symptoms, psychosocial measures and a median 5.9-year follow-up to track hospitalizations. We calculated CVD costs based on cardiac hospitalizations, treatment visits, and CVD medications. Anxiety measures included anxiolytic medication use, Spielberger Trait Anxiety Inventory (STAI) scores, and anxiety disorder treatment history. RESULTS: The sample numbered 514 women with anxiety measure data and covariates (mean age=57.5 [11.1]). One in five (20.4%) women reported using anxiolytic agents. Anxiety correlated with cardiac symptom indicators (anxiolytic use with nighttime angina and nitroglycerine use; STAI scores and anxiety disorder treatment history with nighttime angina, shortness of breath, and angina frequency). Anxiety disorder treatment history (but not STAI scores or anxiolytics) predicted less severe CAD. Anxiolytic use (but not STAI scores or anxiety disorder treatment history) predicted hospitalizations for chest pain and coronary catheterization (HRs=2.0, 95% CIs=1.1-4.7). Anxiety measures predicted higher 5-year CVD costs (+9.0-42.7%) irrespective of CAD severity. CONCLUSIONS: Among women with signs and symptoms of myocardial ischemia, anxiety measures predict cardiac endpoints ranging from cardiac symptom severity to healthcare utilization. Based on these findings, anxiety may warrant greater consideration among women with suspected CAD. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/23410495/Anxiety_associations_with_cardiac_symptoms_angiographic_disease_severity_and_healthcare_utilization:_the_NHLBI_sponsored_Women's_Ischemia_Syndrome_Evaluation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(13)00076-4 DB - PRIME DP - Unbound Medicine ER -