No abstract

BACKGROUND: Although anxiety is common after acute myocardial infarction and can adversely affect physical recovery, it is not part of the routine clinical assessment of patients with myocardial infarction. Furthermore, evidence suggests that patients and clinicians differ significantly in their assessments of patients' anxiety levels. OBJECTIVES: To determine the extent to which clinicians assess anxiety in patients with acute myocardial infarction and to compare patients' self-ratings with their clinicians' assessments. METHODS: In a prospective, descriptive study, 101 patients used the Spielberger State Anxiety Index to assess their anxiety during the first 48 hours after admission for acute myocardial infarction. Patients' scores were compared with nurses' and physicians' assessments of the patients' anxiety as reported in the medical record. RESULTS: Only 45 patients (45%) had anxiety assessments noted in the record. Of those 45, 26 patients (58%) were described simply as anxious without any further description of the level of anxiety. Eleven (24%) of those 45 patients had behaviors of anxiety recorded, again without any indication of the level of anxiety. No association between patients' self-assessments and their clinicians' assessments was apparent (lambda = .03; P > .05). CONCLUSIONS: Anxiety was not routinely assessed, despite nearly half the patients reporting moderate to extreme anxiety when asked. When clinicians assessed anxiety, their assessments did not match patients' self-ratings of anxiety. A simple, easy-to-use instrument for discriminating levels of anxiety is needed.

BACKGROUND: Anxiety after acute myocardial infarction influences both short- and long-term recovery. Therefore, determining specific subgroups of patients who have relatively higher anxiety levels is important. Published findings about gender differences in anxiety after acute myocardial infarction are conflicting. OBJECTIVES: To determine whether gender differences in anxiety after acute myocardial infarction exist and whether any of the sociodemographic and clinical variables that often differ between men and women with acute myocardial infarction interact with gender to influence anxiety. METHODS: A total of 424 patients with confirmed acute myocardial infarction were enrolled in this multicenter prospective study. Patients' anxiety level was measured within 72 hours of their arrival at the hospital by using the State Anxiety Inventory and the Brief Symptom Inventory. RESULTS: Women had significantly higher anxiety than did men according to both the State Anxiety Inventory (42 +/- 12.9 vs 37.7 +/- 12.5; P = .001) and the Brief Symptom Inventory (0.83 +/- 0.97 vs 0.63 +/- 0.71; P = .02). Of the sociodemographic and clinical variables examined, only marital status and income significantly interacted with gender to influence anxiety. Married women had higher anxiety than did single and widowed women, and married men had lower anxiety than did single men. Women with lower income had higher anxiety than did women with higher income; income was not related to anxiety in men. CONCLUSION: Women report significantly greater anxiety early after acute myocardial infarction than men do. Women's greater anxiety may be partially explained by marital status and lower income at the time of the infarction.

BACKGROUND: The 6-minute walk and heart rate variability have been used to assess mortality risk in patients with heart failure, but their relationship to each other and their usefulness for predicting mortality at 1 year are unknown. OBJECTIVE: To assess the relationships between the 6-minute walk test, heart rate variability, and 1-year mortality. METHOD: A sample of 113 patients in advanced stages of heart failure (New York Heart Association Functional Class III-IV, left ventricular ejection < 0.25) were studied. All 6-minute walks took place in an enclosed, level, measured corridor and were supervised by the same nurse. Heart rate variability was measured by using (1) a standard-deviation method and (2) Poincare plots. Data on RR intervals obtained by using 24-hour Holter monitoring were analyzed. Survival was determined at 1 year after the Holter recording. RESULTS: The results showed no significant associations between the results of the 6-minute walk and the two measures of heart rate variability. The results of the walk were related to 1-year mortality but not to the risk of sudden death. Both measures of heart rate variability had significant associations with 1-year mortality and with sudden death. However, only heart rate variability measured by using Poincare plots was a predictor of total mortality and risk of sudden death, independent of left ventricular ejection fraction, serum levels of sodium, results of the 6-minute walk test, and the standard-deviation measure of heart rate variability. CONCLUSIONS: Results of the 6-minute walk have poor association with mortality and the two measures of heart rate variability in patients with advanced-stage heart failure and a low ejection fraction. Further studies are needed to determine the optimal clinical usefulness of the 6-minute walk and heart rate variability in patients with advanced-stage heart failure.

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Nursing Research grant Background Medication adherence is essential to improve health outcomes in patients with heart failure (HF). Depressive symptoms contribute to decrease adherence behaviors. Although social support is helpful to improving medication adherence, perceived social support (PSS) may differ by living arrangement. How social support and living arrangement contribute to the relationship between depressive symptoms and medication adherence is not well understood in patients with heart failure. Purpose The purpose of this study was to determine whether perceived social support and living arrangement moderated the association between depressive symptoms and medication adherence. Methods This was a secondary analysis from outpatients with HF. Depressive symptoms were measured by the Patient Health Questionnaire-9. Perceived social support was assessed using Multidimensional Scale of Perceived Social Support, and patients were grouped into high and low PSS groups using a score of 79, the upper tertile value. Medication adherence was measured objectively by a medication event monitoring system for 3-months. Living arrangement was classified as (1) living with a spouse, (2) living with non-spouse family or friend, or (3) living alone. Moderated moderation analysis was conducted using PROCESS macro (Model 3) in SPSS with 5,000 bootstrap samples. Results Of the total of 208 patients (mean age = 61 ± 11.5 years, 64% male), 60% lived with spouse, 22% lived with non-spousal family or friend, and 26% lived alone. Three-way interaction (depressive symptoms*living arrangement*PSS) was significant (p = 0.0324, Figure 1). The effect of depressive symptoms on medication adherence was only significant for two groups (Figure 2): the living alone group with high PSS (effect = - 4.1855, p = 0.0021), and the living with a non-spousal family group with low PSS (effect = -1.0180, p = 0.0349). For these groups, their depressive symptoms were inversely associated with medication adherence. Conclusions: These results suggest that living arrangement and perceived social support are factors to be considered in medication adherence when planning care for patients with depressive symptoms. Future research is needed to explore whether the combined intervention of improving depressive symptoms and social support focusing on instrumental social support effectively increases medication adherence.