Results from the intervention group in a randomized controlled trial. Lichtman JH, Froelicher ES, Blumenthal JA, Carney RM, Doering LV, Frasure-Smith N, et al. Curr Psychiatry Rep. 2016;18(11):101. doi:10.1007/s11920-016-0739-5. Keeping-Burke L, Purden M, Frasure-Smith N, Cossette S, McCarthy F, Amsel R. Bridging the transition from hospital to home: effects of the VITAL telehealth program on recovery for CABG surgery patients and their caregivers. Another compared exercise to dietary changes (153). The same report states that generalized anxiety disorder (GAD) and panic disorder are up to 15 times higher in people with CAD than in those without. The majority of studies did not include any follow-up after the conclusion of the intervention, and studies with follow-up reported high numbers of patients lost to follow-up which may have served to bias results towards significance (156). Our search terms resulted in 3,660 publications, of which 617 (17%) were duplicates. Two types of CBT are commonly used to treat anxiety disorders: If you have heart disease and an anxiety disorder, there are several steps that you can take to learn how to manage both conditions effectively. (52) provided 6 sessions of weekly telephone counseling addressing cardiac-related fears and reported greater reductions in anxiety for the intervention group to a control group who received a booklet on coping with chronic illness. Effects of a health education programme with telephone follow-up during cardiac rehabilitation. The lack of benefit reported in many studies could be the result of ineffective treatments or may be due to a potential floor effect in which patients had low anxiety to begin with. Journal of cardiopulmonary rehabilitation. If people experience suicidal thoughts or behaviors, they should contact a healthcare professional straight away. Regarding efficacy, only one of the 12 intervention studies that were primarily pharmacological reported lower anxiety in the intervention group compared to controls (60). The. Overview What is an anxiety disorder? Wheatley D. The value of anti-anxiety drugs in the management of cardiac disease. Nine studies reported that participants fit into more than one of these categories. Finally, unlike studies of depression in CHD patients, to our knowledge, no study has examined the effects of treating anxiety on clinical outcomes. Criteria for inclusion in our review were: (1) the study was a RCT; (2) all, or at least a significant proportion of patients, had CHD; (3) anxiety was measured and reported as an outcome; (4) the intervention occurred in an outpatient setting; and (5) the article was published in English in a peer-reviewed journal (i.e., conference abstracts and dissertations were excluded). Funding: This research is supported, in part, by a grant (HL125522) from the National Heart, Lung, and Blood Institute. Lloyd-Jones DM, Larson MG, Beiser A, Levy D. Lifetime risk of developing coronary heart disease. Goodman H, Parsons A, Davison J, Preedy M, Peters E, Shuldham C, et al. Most studies measured anxiety as a secondary outcome, with other outcomes (e.g., depression, quality of life, CHD events) typically serving as the primary outcome. Int J Mol Sci. Turner A, Murphy BM, Higgins RO, Elliott PC, Le Grande MR, Goble AJ, et al. One offered patients a choice between problem solving counseling, antidepressant therapy, or both (37). If you have anxiety and heart disease, managing both conditions can be a challenge. A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. Wang W, Chair SY, Thompson DR, Twinn SF. Anxiety appears to be common among CHD patients. While our EndNote search included terms for panic disorder and phobia, the resulting articles only used instruments measuring generalized anxiety or health-related anxiety. Most importantly, the interventions for the majority of studies were not designed to reduce anxiety, as anxiety was rarely a primary endpoint. Use "positive self-talk" to help overcome your fears. Tips To lessen your fears, start by getting correct and complete information. Exercising regularly can also help reduce stress. Pedersen LR, Olsen RH, Jurs A, Astrup A, Chabanova E, Simonsen L, et al. Dietary Patterns and Their Association with Anxiety Symptoms among Older Adults: The ATTICA Study. Our review found that the STAI and HADS scales were utilized most often in the CHD population, and it may be beneficial for future studies utilize these instruments to facilitate better comparison between studies. 475 records were subjected to full text review, yielding 112 publications that met inclusion criteria plus an additional 7 studies from reference lists and published reviews, yielding 119 studies. Murchie P, Campbell NC, Ritchie LD, Deans HG, Thain J. 1. Celano CM, Millstein RA, Bedoya CA, Healy BC, Roest AM, Huffman JC. Olafiranye O, Jean-Louis G, Zizi F, Nunes J, Vincent M. Anxiety and cardiovascular risk: Review of epidemiological and clinical evidence. Bishop GD, Kaur D, Tan VLM, Chua YL, Liew SM, Mak KH. In patients with heart failure (HF), depression and anxiety disorders are common and associated with adverse outcomes such as reduced adherence to treatment, poor function, increased hospitalizations, and elevated mortality. An anxiety disorder is a type of mental health condition. In contrast, three studies showed minimal benefit: In a 6-month, group therapy intervention for patients scoring >7 on the HADS Anxiety subscale, Merswolken et al. Psychosocial status of patients randomly assigned to medical or surgical therapy for chronic stable angina. Anxious individuals tend to have increased dietary cholesterol intake, eat more food, live a sedentary lifestyle, and exercise less. Another study compared a group receiving progressive muscle relaxation instruction with another receiving mindfulness-based meditation instruction (57). Before International journal of rehabilitation research Internationale Zeitschrift fur Rehabilitationsforschung Revue internationale de recherches de readaptation. Participants were awaiting a coronary procedure, such as a PCI or CABG, in 10 studies. Treatment of Anxiety in Patients With Coronary Heart Disease: A Anxiety has also been independently associated with CHD risk factors, such as hypertension and tobacco use (16). Examples of dosages include: People may take antidepressants in various forms, including: Side effects can vary depending on the type of antidepressant people take but may include: Antidepressants come with a black box warning as they may increase the risk of suicidal thoughts or behavior, particularly in young people. Thank you, {{form.email}}, for signing up. Understanding Anxiety and Heart Disease - Verywell Health One was split evenly between patients hospitalized with MI (23%), unstable angina (26%), congestive heart failure, and arrhythmia (68). (48) reported that an 8-week intervention involving telephone-based CBT, addressing common illness-related fears for patients with elevated anxiety or depressive symptoms, resulted in lower anxiety scores compared to a control group who received a booklet on coping with illness. The challenges of prevention, diagnosis, and treatment of ischemic heart disease in women, Impact of the DMS-IV to DSM-5 changes on the national survey on drug use and health. Ness AR, Gallacher JE, Bennett PD, Gunnell DJ, Rogers PJ, Kessler D, et al. learning the signs of anxiety and heart disease so that people can recognize either condition, talking with a healthcare professional about the possible risks of heart conditions in relation to anxiety and steps to manage the risks, understanding that family history or genetics may play a part in risk for heart conditions, learning which health conditions increase the risk of heart disease, such as high blood pressure, and taking steps to manage them, maintaining a healthy lifestyle, such as increasing physical activity, maintaining a moderate weight, and eating a, avoiding or quitting smoking, if applicable. Wheatley D. Clorazepate in the management of coronary disease. Comparing multifactorial lifestyle interventions and stress management in coronary risk reduction. Mutwalli HA, Fallows SJ, Arnous AA, Zamzami MS. Randomized controlled evaluation shows the effectiveness of a home-based cardiac rehabilitation program. Indian Journal of Physiology and Pharmacology. The British journal of clinical psychology / the British Psychological Society. Blumenthal JA, Feger BJ, Smith PJ, Watkins LL, Jiang W, Davidson J, et al. Furze G, Dumville JC, Miles JN, Irvine K, Thompson DR, Lewin RJ. The educational topics varied between studies. Karakostas D, Papadopoulos CL, Missiopoulou-Kokka A, Vassilopoulos AD, Karamouzis M, Giannakoulis J, et al. If you have an anxiety disorder, you may respond to certain things and situations with fear and dread. Seven studies compared types of exercise: yoga compared to physiotherapy-based cardiac rehabilitation (145), an outdoor walking program compared to indoor cycling (39), low- compared to high-intensity exercise regimens (146, 147), supervised hospital-based CR compared to unsupervised home-based CR (32), and routine CR compared to an expanded program (148, 149). Lv J, Zhang X, Ou S, Gu S, Su Z, Tong S, et al. Finally, two studies compared exercise to counseling (42, 49) and one compared exercise to cardiac education (154). A number of risk factors contribute to the development and progression of CHD, including smoking, hypertension, dyslipidemia, and diabetes. Research has revealed similar prevalence rates in patients with CAD awaiting coronary artery bypass graft (CABG) surgery. However, even those without a previous history are not immune to anxiety or depression. If you have an anxiety disorder, including generalized anxiety disorder (GAD), panic disorder, and post-traumatic stress disorder (PTSD), you are 26% more likely to develop heart diseaseespecially coronary artery disease and heart failure. Heart Disease and Mental Health Disorders | cdc.gov Is the ketogenic diet right for autoimmune conditions? Unfortunately, we identified relatively few intervention studies designed specifically to reduce anxiety in CHD patients, and results of the effectiveness of treatment have been mixed. Workbook including psychoeducation, and audiotaped relaxation program. Based on our ratings for these criteria, we assigned each study an overall quality score. Yu CM, Lau CP, Chau J, McGhee S, Kong SL, Cheung BMY, et al. Twenty-five interventions primarily involved counseling (Table 3). Drugs to Treat Anxiety Disorder The most frequently used scales were the Hospital Anxiety and Depression Scale-Anxiety (HADS) scale (70) used in 45 studies, and the State-Trait Anxiety Inventory (STAI) (71) used in 36 studies. Two additional alternative therapy trials examined fatty acids compared to placebo (41) or omega 3 compared to placebo as an augmentation to the selective serotonin reuptake inhibitor (SSRI), sertraline (40). It is important for clinicians to know the effects of anxiety treatment on clinically relevant outcomes such as symptom burden, utilization of healthcare services, and further acute cardiac events and death. Berkman LF, B J, Burg M, Carney RM, Catellier D, Cowan MJ, Czajkowski SM, DeBusk R, Hosking J, Jaffe A, Kaufmann PG, Mitchell P, Norman J, Powell LH, Raczynski JM, Schneiderman N Enhancing Recovery in Coronary Heart Disease Patients Investigators (ENRICHD) Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. Early programmes of high and low intensity exercise and quality of life after acute myocardial infarction. A randomised controlled trial of a self-management plan for patients with newly diagnosed angina. Moreover, even within treatment classes, the actual interventions were highly variable. Mittag O, China C, Hoberg E, Juers E, Kolenda KD, Richardt G, et al. Faulkner J, Westrupp N, Rousseau J, Lark S. A randomized controlled trial to assess the effect of self-paced walking on task-specific anxiety in cardiac rehabilitation patients. Collins JA, Rice VH. Sundin O, Lisspers J, Hofman-Bang C, Nygren A, Ryden L, Ohman A. (2020). Epidemiology of comorbid coronary artery disease and depression. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Can diet and exercise reverse prediabetes? Mendels J, Chernoff RW, Blatt M. Alprazolam as an adjunct to propranolol in anxious outpatients with stable angina pectoris. Climov D, Lysy C, Berteau S, Dutrannois J, Dereppe H, Brohet C, et al. What Is An Anxiety Attack? doi:10.7205/MILMED-D-16-00378. Anxiety gave her a fake heart attack: Panic attacks have similar Carney RM, Freedland KE. Effects of phase II cardiac rehabilitation on job stress and health-related quality of life after return to work in middle-aged patients with acute myocardial infarction. Yogendra J, Yogendra HJ, Ambardekar S, Lele RD, Shetty S, Dave M, et al. Feelings of extreme agitation and terror are often accompanied by dizziness, chest pains, stomach discomfort, shortness of breath, and rapid heart rate. Blumenthal JA, Sherwood A, Smith PJ, Watkins L, Mabe S, Kraus WE, et al. alprazolam (Xanax) chlordiazepoxide (Librium) clonazepam (Klonopin) diazepam (Valium) lorazepam (Ativan) Benzodiazepines are typically used for short-term treatment of anxiety. It is also possible to inject benzodiazepines, though doctors typically only do this in special circumstances. The majority of studies were conducted with non-anxious patients. Freeman AM, 3rd, Fleece L, Folks DG, Sokol RS, Hall KR, Pacifico AD, et al. Tell your health care professionals about your fears. Pre-Surgery Anxiety? The Anesthesiologist Can Help Many published studies were conducted in non-anxious CHD samples. Effects of n-3 polyunsaturated fatty acids on depressive symptoms, anxiety and emotional state in patients with acute myocardial infarction. health-related concerns, may pre-empt patients to improve lifestyle factors related to CHD development (20). Of the remaining 26 studies, 4 included elevated anxiety in their inclusion criteria (30, 31, 39, 43), 9 included patients with anxiety and/or depression (44-52), 8 included patients with depression, depressive symptoms, or mood disorder only (36, 37, 40, 53-57), 3 included patients with distress (10, 58, 59), one included patients with psychosomatic symptoms including restlessness, anxiety, altered mood, and insomnia (60), and another included patients with exhaustion (61). These behavioral factors in people with anxiety disorders can increase the likelihood of cardiovascular morbidity and mortality. Effects of a Heart Attack on Mental Health - Cleveland Clinic Additionally, although the literature includes a number of RCTs treating depression in CHD patients (24-28), there have been few RCTs targeting anxiety, and to our knowledge, no multi-site RCTs. Could digital puzzle games help improve memory? An integrated secondary prevention group programme reduces depression in cardiac patients. van Dixhoorn J, Duivenvoorden HJ, Pool J, Verhage F. Psychic effects of physical training and relaxation therapy after myocardial infarction. The quality of studies was also highly variable. Psychosomatics. Rudisch B, Nemeroff CB. Two studies showed group differences in anxiety after treatment. Elevated anxiety was an inclusion criterion in only 4 studies, with inconsistent results. The British journal of general practice : the journal of the Royal College of General Practitioners. Worcester MC, Hare DL, Oliver RG, Reid MA, Goble AJ. Fourteen studies primarily involved relaxation therapies (Table 2), at times delivered as adjunct to exercise-based CR. Another included patients hospitalized with primary diagnoses of acute coronary syndrome (22%), unspecified heart failure (68%), or aortic stenosis (10%) (65). Psychological rehabilitation after myocardial infarction: multicentre randomised controlled trial. It is interesting that these studies reported improvements in anxiety at a much greater rate than studies of patients with anxiety alone, or studies targeting patients with neither. Medicine and science in sports and exercise. There has been a relative paucity of studies concerning treatment of anxiety in CHD patients. Written by Julie Davis. Typical education, one-time session with Q&A with a nurse and written information. Omega-3 augmentation of sertraline in treatment of depression in patients with coronary heart disease: a randomized controlled trial. Best Anxiety Medication For Heart Patients (2023 Updated) Although anxiety is common in the CHD population and has been associated with increased risk for adverse events in some studies, the value of treating anxiety in these patients has received considerably less attention compared to depression(30, 31). Next, the first author (JF) conducted a review at the abstract level and selected for full text review only those studies that appeared to fit all inclusion criteria. Research has shown that people who exercise more regularly have better-managed anxiety levels. Phase 2 Randomised Controlled Trial and Feasibility Study of Future Care Planning in Patients with Advanced Heart Disease. Ultimately, 119 studies were included in our review. Effects of phase III cardiac rehabilitation programs on health-related quality of life in elderly patients with coronary artery disease - Juntendo cardiac rehabilitation program (J-CARP). A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart disease. A 10-year study of 2,956 American women across multiple races and ethnicities found that women with low anxiety pre-menopausally may actually be more susceptible to high anxiety during and after the menopausal transition than before. An official website of the United States government. Medicine intended for your heart may help in certain anxiety-provoking situations It's not uncommon for certain situations to make your heart pump a bit faster or make your hands start a-trembling. Try to remove any weapons, medications, or other potentially harmful objects. Other studies examined the effects of medications that treat CHD or CHD risk factors, . Depression as a Risk Factor for Poor Prognosis Among Patients With Acute Coronary Syndrome: Systematic Review and Recommendations. Nitte University Journal of Health Science. Association between anxiety and mortality in patients with coronary artery disease: A meta-analysis. Certain lifestyle factors may increase the risk of heart issues, and chronic health conditions may also increase the risk of anxiety disorders. The best medications for depression, anxiety, and ADHD - Medical News Today When you have a palpitation, you may feel your heart beating in your chest, neck or throat. Tully PJ, Cosh SM, Baune BT. Anxiety is a common cause of excessive hypertension and therefore antianxiety treatment may be beneficial in these patients. 2023 Healthline Media UK Ltd, Brighton, UK. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Here are a few of them: Panic disorder - can be associated with cardiac disease or mistaken for heart attack. For example, there was only one study in the 119 we reviewed that utilized SSRI medications as a primary intervention. Participants were considered to have had stable CHD in 26 studies. The site is secure. The UPBEAT nurse-delivered personalized care intervention for people with coronary heart disease who report current chest pain and depression: a randomised controlled pilot study. Andriy Onufriyenko/Getty Images The 'typical' long COVID patient. Six studies compared an exercise intervention paired with education or counseling, to a control group with usual care (receiving neither exercise training nor education/counseling) (50, 51, 141-144). Although there have been a number of RCTs of CHD patients that assessed anxiety, in most cases anxiety was a secondary outcome, and only one third found that symptoms of anxiety were reduced with treatment. government site. Furze G, Cox H, Morton V, Chuang LH, Lewin RJ, Nelson P, et al. Anxiety Disorders: Types, Causes, Symptoms & Treatments - Cleveland Clinic Dietary Patterns and Their Association with Anxiety Symptoms among Older Adults: The ATTICA Study, Self-Management Strategies for Stress and Anxiety Used by Nontreatment Seeking Veteran Primary Care Patients. Options include beta blockers and antidepressants. and transmitted securely. Other scales used less frequently (i.e., used in <4 studies) included the Anxiety Scale Questionnaire, Beck Anxiety Inventory, Brief Symptom Inventory Anxiety Subscale, Cattell Self-Analysis form, Covi Scale, Derogatis Stress Profile, General Practitioner Research Group Nine-Item Anxiety Rating Scale, General Health Questionnaire-Anxiety, Hamilton Anxiety Rating Scale, Hopkins Symptom Check-List Self Rating Scale for Anxiety, Kessler scale, Multiple Affect Adjective Checklist, Profile of Mood States-Anxiety, the Patient-Reported Outcomes Measurement Information System anxiety items, Self-Rating Anxiety Scale, Symptoms of Anxiety-Depression Index, the anxiety subscale of the Symptom Checklist-90 form, Symptom Rating Test, Symptom Questionnaire, Taylor Manifest Anxiety scale, Welsh's Anxiety Scale, and a single anxiety item using a Likert scale.