Impact of anxiety on the post-discharge outcomes of patients discharged from the hospital after an acute coronary syndrome

UMMS Affiliation

Department of Quantitative Health Sciences; Department of Psychiatry; Graduate School of Biomedical Sciences; Department of Psychiatry; Implementation Science and Practice Advances Research Center

Publication Date


Document Type



Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Epidemiology | Mental and Social Health | Psychiatry | Psychiatry and Psychology


BACKGROUND: Symptoms of anxiety are highly prevalent among survivors of an acute coronary syndrome (ACS), but do not necessarily indicate an anxiety disorder. The extent to which symptoms of anxiety or a diagnosis of this condition impacts hospital readmission and post-discharge mortality among patients with an ACS remains unclear.

METHODS: We used data from 1909 patients discharged from six hospitals in Massachusetts and Georgia after an ACS. Moderate/severe symptoms of anxiety were defined based on responses to a Generalized Anxiety Disorder questionnaire during the patient's index hospitalization. The diagnosis of an anxiety disorder was based on review of hospital medical records. Multivariable adjusted Poisson regression and Cox proportional-hazards models were used to estimate the risk of 30-day hospital readmissions and 2-year total mortality.

RESULTS: The mean age of the study population was 61 years, two thirds were men, and 78% were non-Hispanic whites. In this population, 10.4% had a documented diagnosis of an anxiety disorder, 18.8% had moderate/severe symptoms of anxiety, and 70.8% had neither a diagnosis nor symptoms of anxiety. Neither a diagnosis of an anxiety disorder nor symptoms of anxiety were associated with 30-day all-cause or cardiovascular-related rehospitalizations. Patients with an anxiety disorder (multivariable adjusted HR=1.95, 95%CI=1.11-3.42) were at greatest risk for dying during the 2-year follow-up period.

CONCLUSIONS: We identified patients with an anxiety disorder as being at greater risk for dying after hospital discharge for an ACS. Interventions may be more appropriately targeted to those with a history of, rather than acute symptoms of, anxiety.


Acute coronary syndrome, Anxiety, Mortality, Rehospitalization

DOI of Published Version



Int J Cardiol. 2019 Mar 1;278:28-33. doi: 10.1016/j.ijcard.2018.09.068. Epub 2018 Sep 20. Link to article on publisher's site

Journal/Book/Conference Title

International journal of cardiology

Related Resources

Link to Article in PubMed

PubMed ID