Complications after acute coronary syndrome are reduced by perceived control of cardiac illness

Aims. To investigate the relationship between anxiety, perceived control and rate of in-hospital complications after acute coronary syndrome. Background. Anxiety may be associated with higher risk of complications following acute myocardial infarction; perceived control may moderate this relationship. Design. Prospective observational study. Methods. Patients enrolled in a trial investigating delay in seeking treatment for acute coronary syndrome had anxiety measured at enrolment and 3months using the Brief Symptom Inventory anxiety subscale. The acute coronary syndrome hospital presentations investigated occurred between 2001-2006. Patients with anxiety scores greater than the population norm at both time points were categorized as persistently anxious. Perceived control was measured at enrolment using the Control Attitudes Scale-Revised. Data were collected from the medical record on in-hospital complications in patients presenting with acute coronary syndrome within 2years of enrolment. Chi-square and t-tests were used for univariate analyses and multiple logistic regression to identify independent predictors of complications. Results. Patients (n=171) were 64% men with mean age 69years. Ischaemic or arrhythmic complications occurred in 26 patients (15%) with no difference in complication rates between those persistently anxious and others. Important univariate predictors of in-hospital complications were lower perceived control, diagnosis of acute myocardial infarction, heart failure and higher pulse rate on admission. Low perceived control and diagnosis of acute myocardial infarction were independent predictors of in-hospital complications in the multiple logistic regression. Conclusion. Perceived control, but not persistent anxiety, prior to acute coronary syndrome was an important predictor of in-hospital complications after acute coronary syndrome. Interventions to increase cardiac patients' perceived control of their cardiac illness may reduce in-hospital complications after acute coronary syndrome.