Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysis
Objectives Anxiety has been suggested to be associated with poor outcomes in patients with acute coronary syndrome (ACS). However, results of previous follow-up studies were inconsistent. The aim of this meta-analysis was to evaluate the association between anxiety and clinical outcomes in patients...
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BMJ Publishing Group
2020-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/7/e034135.full |
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| author | Jie Li Chuanjun Zhuo Feng Ji Junxian Song Xiangyang Gao Deguo Jiang Guangdong Chen Suling Chen Xiaodong Lin |
| author_facet | Jie Li Chuanjun Zhuo Feng Ji Junxian Song Xiangyang Gao Deguo Jiang Guangdong Chen Suling Chen Xiaodong Lin |
| author_sort | Jie Li |
| collection | DOAJ |
| description | Objectives Anxiety has been suggested to be associated with poor outcomes in patients with acute coronary syndrome (ACS). However, results of previous follow-up studies were inconsistent. The aim of this meta-analysis was to evaluate the association between anxiety and clinical outcomes in patients with ACS, and to investigate the potential role of depression underlying the above association.Design A meta-analysis of prospective follow-up studies.Setting Hospitals.Participants Patients with ACS.Interventions We included related prospective follow-up studies up through 20 July 2019 that were identified by searching PubMed and Embase databases. A random-effect model was used for the meta-analysis. Anxiety was evaluated by validated instruments at baseline.Primary and secondary outcome measures We determined the association between anxiety and risks of mortality and adverse cardiovascular events (MACEs) in patients with ACS.Results Our analysis included 17 studies involving 39 038 patients wqith ACS. Anxiety was independently associated with increased mortality risk (adjusted risk ratio (RR) 1.21, 95% CI 1.07 to 1.37, p=0.002) and MACEs (adjusted RR 1.47, 95% CI 1.24 to 1.74, p<0.001) in patients with ACS. Subgroup analyses showed that depression may at least partly confound the association between anxiety and poor outcomes in patients with ACS. Adjustment of depression significantly attenuated the association between anxiety and MACEs (adjusted RR 1.25, 95% CI 1.04 to 1.52, p=0.02). Moreover, anxiety was not significantly associated with mortality risk after adjusting for depression (adjusted RR 0.88, 95% CI 0.66 to 1.17, p=0.37).Conclusions Anxiety is associated with increased risk of mortality and MACEs in patients with ACS. However, at least part of the association may be confounded by concurrent depressive symptoms in these patients. |
| format | Article |
| id | doaj-art-40fb54dd3c8f4279bd27b6f2425a28b1 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-40fb54dd3c8f4279bd27b6f2425a28b12025-08-20T02:19:30ZengBMJ Publishing GroupBMJ Open2044-60552020-07-0110710.1136/bmjopen-2019-034135Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysisJie Li0Chuanjun Zhuo1Feng Ji2Junxian Song3Xiangyang Gao4Deguo Jiang5Guangdong Chen6Suling Chen7Xiaodong Lin8Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai, Shanghai, ChinaPsychiatric Neuroimaging–Genetic and Comorbidity Laboratory (PNGC_Lab), Tianjin Mental Health Centre, Tianjin Anding Hospital, Tianjin, ChinaDepartment of Psychiatric-Neuro-Imaging-Genetics Laboratory, School of Mental of Jining Medical University, Jining, ChinaDepartment of Cardiology, Center for Cardiovascular Translational Research, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People’s Hospital, Beijing, ChinaHealth Management Institute, Medical Data Statistical Analysis Center, Medical Big Data Analysis Center, Chinese PLA General Hospital, Beijing, ChinaPsychiatric Neuroimaging–Genetic and Comorbidity Laboratory (PNGC_Lab), Tianjin Mental Health Centre, Tianjin Anding Hospital, Tianjin, ChinaPsychiatric Neuroimaging–Genetic and Comorbidity Laboratory (PNGC_Lab), Tianjin Mental Health Centre, Tianjin Anding Hospital, Tianjin, ChinaPsychiatric Neuroimaging–Genetic and Comorbidity Laboratory (PNGC_Lab), Tianjin Mental Health Centre, Tianjin Anding Hospital, Tianjin, ChinaDepartment of Medical Imaging, the First Affiliated Hospital, Dali University, Dali, ChinaObjectives Anxiety has been suggested to be associated with poor outcomes in patients with acute coronary syndrome (ACS). However, results of previous follow-up studies were inconsistent. The aim of this meta-analysis was to evaluate the association between anxiety and clinical outcomes in patients with ACS, and to investigate the potential role of depression underlying the above association.Design A meta-analysis of prospective follow-up studies.Setting Hospitals.Participants Patients with ACS.Interventions We included related prospective follow-up studies up through 20 July 2019 that were identified by searching PubMed and Embase databases. A random-effect model was used for the meta-analysis. Anxiety was evaluated by validated instruments at baseline.Primary and secondary outcome measures We determined the association between anxiety and risks of mortality and adverse cardiovascular events (MACEs) in patients with ACS.Results Our analysis included 17 studies involving 39 038 patients wqith ACS. Anxiety was independently associated with increased mortality risk (adjusted risk ratio (RR) 1.21, 95% CI 1.07 to 1.37, p=0.002) and MACEs (adjusted RR 1.47, 95% CI 1.24 to 1.74, p<0.001) in patients with ACS. Subgroup analyses showed that depression may at least partly confound the association between anxiety and poor outcomes in patients with ACS. Adjustment of depression significantly attenuated the association between anxiety and MACEs (adjusted RR 1.25, 95% CI 1.04 to 1.52, p=0.02). Moreover, anxiety was not significantly associated with mortality risk after adjusting for depression (adjusted RR 0.88, 95% CI 0.66 to 1.17, p=0.37).Conclusions Anxiety is associated with increased risk of mortality and MACEs in patients with ACS. However, at least part of the association may be confounded by concurrent depressive symptoms in these patients.https://bmjopen.bmj.com/content/10/7/e034135.full |
| spellingShingle | Jie Li Chuanjun Zhuo Feng Ji Junxian Song Xiangyang Gao Deguo Jiang Guangdong Chen Suling Chen Xiaodong Lin Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysis BMJ Open |
| title | Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysis |
| title_full | Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysis |
| title_fullStr | Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysis |
| title_full_unstemmed | Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysis |
| title_short | Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysis |
| title_sort | anxiety and clinical outcomes of patients with acute coronary syndrome a meta analysis |
| url | https://bmjopen.bmj.com/content/10/7/e034135.full |
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