The association between anxiety disorders and in‐hospital outcomes in patients with myocardial infarction

Abstract

BackgroundAnxiety disorders are prevalent in patients with myocardial infarction (MI), but the effects of anxiety disorders on in‐hospital outcomes within MI patients have not been well studied.HypothesisTo examine the effects of concurrent anxiety disorders on in‐hospital outcomes in MI patients.MethodsWe conducted a retrospective cohort study in patients with a principal diagnosis of MI with and without anxiety disorders in the National Inpatient Sample 2016. A total of 129 305 primary hospitalizations for acute MI, 35 237 with ST‐segment elevation myocardial infarction (STEMI), and 94 068 with non‐ST elevation myocardial infarction (NSTEMI) were identified. Of these, 13 112 (10.1%) had anxiety (7.9% in STEMI and 11.0% in NSTEMI). We compared outcomes of anxiety and nonanxiety groups after propensity score matching for the patient and hospital demographics and relevant comorbidities.ResultsAfter propensity score matching, the anxiety group had a lower incidence of in‐hospital mortality (3.0% vs 4.4%, P < .001), cardiac arrest (2.1% vs 2.8%, P < .001), cardiogenic shock (4.9% vs 5.6%, P = .007), and ventricular arrhythmia (6.7% vs 7.9%, P < .001) than the nonanxiety group. In the NSTEMI subgroup, the anxiety group had significantly lower rates of in‐hospital mortality (2.3% vs 3.5%, P < .001), cardiac arrest (1.1% vs 1.5%, P = .008), and cardiogenic shock (2.8% vs 3.5%, P = .008). In the STEMI subgroup, we found no differences in in‐hospital outcomes (all P > .05) between the matched groups.ConclusionAlthough we found that anxiety was associated with better in‐hospital outcomes, subgroup analysis revealed that this only applied to patients admitted for NSTEMI instead of STEMI.

Anxiety, Mental Stress, and Sudden Cardiac Arrest: Epidemiology, Possible Mechanisms and Future Research

“…The publications were subdivided into three types of observational studies (Table 1). In type I, researchers directly examined the association between the presence or severity of anxiety and subsequent SCA or SCD (n = 7 studies) (17)(18)(19)(20)(21)(22)(23). In type II, researchers compared the rates of SCA or SCD during or directly after a public event likely to be accompanied by mental stress (Covid-19 pandemic, earthquakes, terrorist attack, important football tournaments) with those during control periods (n = 8 studies) (24)(25)(26)(27)(28)(29)(30)(31).…”

“…Longer time intervals are required to study anxiety/mental stress as a predisposing factor, and short time intervals are appropriate to study anxiety/mental stress as a triggering factor. In type I studies, SCA in the general population was examined over time intervals of 2 years (23), 12 years (20), and 32 years (22), whereas studies in populations at risk generally used a shorter time interval (1-3 years) (17)(18)(19)21). By contrast, type II studies assessed SCA during or in the days or weeks following the emotionally charged event.…”

“…Type I: Anxiety and Fatal or Non-fatal SCA Seven studies examined the association between anxiety and SCA or SCD during follow-up, five of which used a prospective cohort design (18)(19)(20)(21)23), one used a retrospective cohort (17), and one a case-control ( 22) design. In one study, the exposure was based on pre-existing anxiety disorders (17), whereas most studies used severity of anxiety symptoms, i.e., the state portion of Spielberger's State-Trait Anxiety Inventory (STAI-S) (18,21), the phobic anxiety subscale of the Crown-Crisp experiential index (CCEI) (19,20,23), or anxiety symptoms based on the Cornell Medical Index (CMI) (22). Follow-up duration ranged from 1 to 32 years.…”

“…In the other study, however, it was mentioned that all cases of arrhythmic events over the 1-year follow-up period occurred in men (21). Finally, a large retrospective cohort using the 2016 National Inpatient Sample data of MI patients showed a protective effect of pre-existing anxiety disorders on the incidence of in-hospital SCA, but only in non-ST segment elevation MI patients (17). Pooling the unadjusted associations of these studies between baseline anxiety and incidence of SCA resulted in highly heterogeneous effect estimates, with the pooled odds for higher symptoms of anxiety not being significantly different from low symptoms of anxiety (OR = 1.15, 95%CI 0.69-1.91; Figure 2).…”