Background: The frequency of anxiety disorders in coronary disease is approximately 15%, while according to research, 24-72% of patients undergoing elective coronary angiography experience clinically significant anxiety. Anxiety negatively affects participation in treatment and rehabilitation. The purpose of our research was to define predictive factors for better recognition of anxiety in patients invited to elective coronary angiography and to identify the phenotype of patients that would need pharmacological or non-pharmacological help to manage anxiety before and/or after the procedure. We also determined the psychometric properties of the translated Cardiac Depression Scale.
Methods: This was a single-center, cross-sectional, prospective study at the Coronary Care Unit of the Department of Cardiology, Celje General Hospital, Slovenia. In this study 393 patients that underwent the elective coronary angiography were included. Psychological parameters were measured using self-assessment questionnaires (anxiety using the Spielberger Trait/State Anxiety Inventory, personality traits using the 10 – item short version of Big Five Inventory, coping with stress using the Coping Inventory, and depressive symptoms using the Cardiac Depression Scale and the Center for Epidemiologic Studies Depression Scale). The data was collected within a period of six weeks from the patient's inclusion in the study at four time points: (1) 14 days before the procedure, (2) on the day of admission to the hospital approximately 2-4 hours before the procedure, (3) 24 hours after the procedure but before discharge and (4) 4 weeks after discharge. 272 patients met the inclusion criteria for determining the psychometric properties of the Cardiac Depression Scale, while 259 patients without depression symptoms were included in the analysis of anxiety.
Results: Among 259 patients (median age 65 years, 32% women), 91 patients were anxious (prevalence of anxiety 35%). Anxiety was higher in patients with avoidance-oriented coping style (p<0.001). Patients without any intervention (p=0.073) and with percutaneous coronary intervention (p=0.069) had lower anxiety, compared to patients in need of coronary graft-bypass surgery. The Slovenian version of the Cardiac Depression Scale had good internal consistency (Cronbach's alpha=0.92) and temporal stability (ICC=0.71). Exploratory factor analysis confirmed six factors, which explained 61% of the total variability. Concurrent validity with the Center for Epidemiologic Studies Depression Scale and the Spielberger State Anxiety Inventory showed a significant to strong correlation.
Conclusion: More than one third of patients experience clinically significant anxiety before elective coronary angiography. Patients that use avoidance-oriented coping strategies and need a coronary artery bypass graft surgery have higher trait and state anxiety. Our results suggest importance of recognising anxiety to apply effective interventions for altering coping strategies and reducing anxiety and its effect on cardiovascular system. The Slovenian version of the Cardiac Depression Scale is a reliable and valid instrument for screening for depression in Slovenian patients with heart disease.
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