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Course of Anxiety Symptoms Over an 18-Month Period in Exhausted Patients Post Percutaneous Coronary Intervention

From CoRPS—Center of Research on Psychology in Somatic diseases (S.S.P., O.R.F.S., J.D.V., J.D.), Tilburg University, Tilburg, Netherlands; and the Department of Medical Psychology (A.A.), Maastricht University, Maastricht, Netherlands.

Address correspondence and reprint requests to Susanne S. Pedersen, CoRPS, Department of Medical Psychology, Room P506, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE Tilburg, Netherlands. E-mail: s.s.pedersen{at}uvt.nl

Objective: Anxiety is a neglected risk factor in coronary artery disease. We examined the different courses of anxiety over an 18-month period in patients post percutaneous coronary prevention (PCI) and the predictors of group membership of these courses.

Methods: Consecutive exhausted PCI patients (n = 638), participating in the EXhaustion Intervention Trial (EXIT), were assessed for depression at baseline using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition and for symptoms of anxiety at baseline, 6, and 18 months using the State Trait Anxiety Inventory (state only). SAS procedure TRAJ was used to examine courses of anxiety symptoms over an 18-month period.

Results: Five trajectories were identified: nonanxious (13.2%), mildly anxious (39.7%), decreasingly anxious (11.6%), moderately anxious (29.3%), and severely anxious (6.3%), with four of them being stable over 18 months. Multinomial logistic regression analyses showed that angina pectoris, major depression, the use of anxiolytics, and low educational level distinguished moderate-to-severe anxious patients from nonanxious. The absence of angina and major depression and not using diuretics explained the decreasing trend in anxiety in one of the trajectories.

Conclusions: Anxiety trajectories varied across patients, with four of five being stable over 18 months. In clinical practice, knowledge of these trajectories and their determinants may help identify distinct groups of patients with potentially differential risks of adverse health outcomes.

Key Words: anxiety • determinants • exhaustion • percutaneous coronary intervention • trajectories

Abbreviations: ASR = adjusted standardized residual; BIC = Bayesian information criterion; CAD = coronary artery disease; CI = confidence interval; DSM = Diagnostic and Statistical Manual of Mental Disorders; EXIT = EXhaustion Intervention Trial; LVEF = left ventricular ejection fraction; MI = myocardial infarction; OR = odds ratio; PCI = percutaneous coronary intervention; QoL = quality of life; STAI = State Trait Anxiety Inventory.