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

Title
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
Publication Date
2014-12
Author(s)
Tully, Phillip J
( author )
OrcID: https://orcid.org/0000-0003-2807-1313
Email: ptully2@une.edu.au
UNE Id une-id:ptully2
Cosh, Suzanne M
( author )
OrcID: https://orcid.org/0000-0002-8003-3704
Email: scosh@une.edu.au
UNE Id une-id:scosh
Baumeister, Harald
Type of document
Journal Article
Language
en
Entity Type
Publication
Publisher
Elsevier Inc
Place of publication
United States of America
DOI
10.1016/j.jpsychores.2014.10.001
UNE publication id
une:1959.11/26973
Abstract
Objective: To (1) report the prognostic association between anxiety disorder subtypes and major adverse cardiac events (MACE), (2) report anxiety disorder prevalence in coronary heart disease (CHD), and (3) report the efficacy of anxiety disorder treatments in CHD. Methods: A comprehensive electronic database search was performed in November 2013 for studies reporting anxiety disorder prevalence according to structured interview in CHD samples or MACE, and randomized controlled trials (RCTs) comparing anxiety disorder treatment with placebo or usual care. From 4041 articles 42 samples were selected for extraction (8 for MACE prognosis, 39 for prevalence, no RCTs were eligible). Results: Five generalized anxiety disorder (GAD) studies reported 883 MACE events (combined n = 2851). There was a non-significant association between GAD and MACE (risk ratio = 1.20, 95% CI .86-1.68, P = .28) however the effect size was highly significant in outpatient samples (adjusted hazard ratio = 1.94, 95% CI 1.45-2.60, P < .001). No other anxiety disorder subtype was associated with MACE. Prevalence data showed high comorbidity with depression (49.06%; 95% CI 34.28-64.01) and substantial heterogeneity between studies. Panic disorder prevalence was higher in psychiatrist/psychologist raters (9.92% vs. 4.74%) as was GAD (18.45% vs. 13.01%). Panic and GAD estimates were also heterogeneous according to DSM-III-R versus DSM-IV taxonomies. Conclusions: The paucity of extant anxiety disorder RCTs, alongside MACE risk for GAD outpatients, should stimulate further anxiety disorder intervention in CHD populations. Research should focus on depression and anxiety, thereby unraveling disorder specific and more generic pathways.
Link
Citation
Journal of Psychosomatic Research, 77(6), p. 439-448
ISSN
1879-1360
0022-3999
Pubmed ID
25455809
Start page
439
End page
448

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