Anxiolytic medication use is not associated with anxiety level and does not reduce complications after acute myocardial infarction

Evidence of Arabic Version of the Control Attitude Scale-Revised Efficacy to Measure Perceived Control in Acute Myocardial Infarction Patients

BACKGROUND AND PURPOSE

Perceived control plays a vital role in controlling negative consequences during disease process. The purpose of this study was to test the psychometric properties of the Arabic version of the Control Attitudes Scale-Revised (CAS-R) among patients with acute myocardial infarction (AMI).

METHODS

375 patients with a confirmed diagnosis of AMI participated in this study. Reliability was assessed by Cronbach's alpha, item-total correlations, and interitem correlations. Construct validity was examined by hypotheses testing.

RESULTS

Cronbach's alpha was .85. All items were homogenous, since item-total correlation coefficients and interitem correlation coefficients were acceptable. Perceived control has a protective effect against anxiety and complications, supporting the construct validity.

CONCLUSIONS

The Arabic version of the CAS-R is a valid and reliable instrument to measure perceived control in patients with AMI.

Patients with ST segment elevation myocardial infarction: moderating effect of perceived control on the relationship between depression and in-hospital complications

BACKGROUND

Cardiovascular diseases remain the top global killer, with nearly 80% of related mortalities occurring in developing countries. Over half of cardiovascular diseases' mortality is due to coronary heart disease, which is commonly linked to acute myocardial infarction. Psychological factors (i.e., depression and anxiety) after acute myocardial infarction are associated with higher levels of complications and mortality. Perceived control moderated the effect of anxiety on complications in different cardiac populations, but impacts on depression and complications after acute myocardial infarction are not well studied. This study explores the moderating effect of perceived control on the relationship between depression and complications after ST segment elevation myocardial infarction.

METHODS

Three hundred patients with a confirmed diagnosis of ST segment elevation myocardial infarction participated in this prospective observational study. Patients answered socio-demographic data, the depression subscale of the Hospital Anxiety and Depression Scale (HADS), and the Control Attitude Scale-Revised (CAS-R) questionnaires. In-hospital complications and all other necessary data were extracted from medical records after discharge. Data were analyzed using logistic regression.

RESULTS

24% developed at least one complication. Patients with high depression scores (8-21) were more likely to develop complications (χ² = 34.15, p < .001) than those with low depression scores (0-7). Patients with high levels of perceived control had lower levels of depression than those with low perceived control (mean [SD], 9.47 [6.43] vs. 12.31 [6.66], p < .001). The results of logistic regression showed that perceived control moderated the association between depression and complications, since depression scores, perceived control scores, and the interaction between depression and perceived control were significant predictors of complications. Participants with high depression and low perceived control had the highest rate of complications (31.5% vs. 15.4%, P < .001).

CONCLUSIONS

Depression increased complications after ST segment elevation myocardial infarction. Perceived control moderated this relationship. Assessment of depression and enhancement of perceived control in patients with acute myocardial infarction can decrease complications and improve outcomes.

Depressive Symptoms and Complications Early after Acute Myocardial Infarction: Gender Differences

Background:

Cardiovascular disease is the first leading cause of death worldwide. Coronary heart disease is the most common manifestation of cardiovascular disease. Acute myocardial infarction is the primary manifestation of coronary heart disease. Depression is a common and predicted complication after acute myocardial infarction. Limited studies evaluated gender differences in depressive symptoms after acute myocardial infarction especially in developing countries.

Objective:

The study aimed to determine whether there was a difference in depression levels and rate of complications based on gender early after acute myocardial infarction.

Method:

This was a prospective comparative study on 230 patients (150 men and 80 women) with a confirmed diagnosis of acute myocardial infarction. All participants signed an informed consent, filled sociodemographic and clinical questionnaire and the Depression Subscale of the Hospital Anxiety and Depression Scale. Clinical data were abstracted from the participants’ medical record after discharge.

Results:

Eighty-six participants (37.4%), 54 men and 32 women, developed 1 or more complications during hospitalization. Female patients were more depressed (14.4±3.5 vs. 8.3 ± 2.6) and developed more complications (1.9 ± 0.9 vs. 0.8 ± 0.5) than male patients did. Depressive symptoms increased the occurrence of complication by 40% and 33% for female and male patients respectively after controlling for sociodemographic and clinical variables.

Conclusion:

Depressive symptoms independently predicted complications after acute myocardial infarction in both men and women. The inclusion of depression assessment tools in acute myocardial infarction treatment protocols is highly recommended.

Perceived control moderates the relationship between anxiety and in-hospital complications after ST segment elevation myocardial infarction

Purpose

Anxiety is a common psychological response after acute myocardial infarction and might be associated with higher levels of in-hospital complications. Perceived control might moderate this relationship, but the effect of this method has not been checked in developing countries. Therefore, the objectives of this study were as follows: 1) to check if anxiety was an independent predictor of in-hospital complications after acute myocardial infarction; and 2) to check if perceived control moderates the relationship between anxiety and in-hospital complications after acute myocardial infarction.

Patients and methods

This was a prospective observational study among 500 patients with a confirmed diagnosis of ST segment elevation myocardial infarction recruited from three private hospitals in Amman, Jordan. Anxiety was measured by the Anxiety subscale of Hospital Anxiety and Depression Scale, and perceived control was measured by the Arabic version of the Control Attitude Scale-Revised.

Results

One hundred and forty patients (28%) developed at least one complication during hospitalization. Two hundred and fifty-five patients had low anxiety scores (≤7), and 245 patients had high anxiety scores (≥8). Patients with high levels of perceived control had lower levels of anxiety (mean [SD]; 5.3 [3.6] vs 14.1 [6.3], P<0.001) than those with low perceived control. In logistic regression, anxiety was an independent predictor of in-hospital complications after controlling for sociodemographic and clinical variables (odds ratio: 1.24, 95% CI, 1.08–1.41, P<0.01). Moreover, the interaction of anxiety and perceived control was a significant predictor of complications.

Conclusion

Anxiety was associated with increased risk of in-hospital complications after acute myocardial infarction independent of sociodemographic and clinical variables. Perceived control had a moderating effect for this association since the combination of low perceived control and high anxiety scores was associated with the greatest risk for complications. Supporting patients’ levels of perceived control can decrease complications, morbidities, and mortality after acute myocardial infarction.