15 Oct Anxiety Disorders Common in Patients With Coronary Heart Disease
MedicalResearch.com Interview with:
Phil Tully PhD
Early Career Research Fellow, Discipline of Medicine
University of Adelaide Australia and
Abteilung für Rehabilitationspsychologie und Psychotherapie
Institut für Psychologie, Universität Freiburg Freiburg Germany
Medical Research: What are the main findings of the study?
Response: The systematic review indicated that anxiety disorders ascertained by clinical interview are highly prevalent in patients with verified coronary heart disease. Also, approximately 50% of anxiety disorders were comorbid with depression. There was however some uncertainty in prevalence estimates with high level heterogeneity observed between studies. It was also evident that studies measuring generalized anxiety disorder in outpatient samples reported an increased prognostic risk for major adverse cardiac events in the longer term, when adjusted for confounding factors, however there was limited data. There were no randomized controlled trials targeting anxiety disorders in this population.
Medical Research: What was most surprising about the results?
Response: It was surprising to observe that anxiety disorders were at least as common as depression in verified coronary heart disease, considering that anxiety disorders have largely been overlooked in this population until our review. It was also intriguing to observe the differential prevalence of anxiety disorder subtypes between studies we reviewed, especially panic disorder as this diagnosis appears to be a problematic diagnosis to make in persons with verified heart disease. Nevertheless, it was also surprising to note the paucity of high quality research regarding anxiety disorder subtypes in relation to longer term cardiac outcomes, and this could be improved upon in larger samples to provide more definitive answers. It was unexpected that no anxiety disorder randomized controlled trials met inclusion criteria for our review.
Medical Research: What should clinicians and patients take away from your report?
Response: Clinicians should firstly take note of the high prevalence of anxiety in persons with heart disease alongside the absence of randomized controlled trial evidence. Clinicians should also closely examine some of the factors that were found to influence the anxiety disorder prevalence estimates. It is noteworthy that some evidence indicates an association between generalized anxiety disorder and cardiac prognosis.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: Larger prospective studies are required to examine anxiety disorder-specific mechanisms and those associated with comorbid anxiety and depression. The paucity of extant anxiety disorder interventions in coronary heart disease warrants pilot studies or randomized controlled trials.
The Anxious Heart in Whose Mind? A Systematic Review and Meta-Regression of Factors Associated with Anxiety Disorder Diagnosis, Treatment and Morbidity Risk in Coronary Heart Disease
Tully, Phillip J. et al.
Published Online: October 13, 2014
Journal of Psychosomatic Research