Citation/Abstract

The purpose of this dissertation was to investigate the effect of anxiety on in-hospital complications in patients hospitalized for acute coronary syndrome (ACS). The specific aims were to: (1) review the effect of anxiety on autonomic control of the heart and cardiac dysrhythmeogensis in patients with ACS; (2) test the reliability and validity of the Brief Symptom Inventory in patients hospitalized with ACS; (3) compare number of complications and length of hospital stay (LOS) among patients with ACS with different levels of anxiety who received beta-blockers during hospitalization; (4) determine the effect of persistent anxiety measured prior to an event on subsequent in-hospital complications in patients admitted for ACS events after controlling for demographic and clinical variables; and (5) determine the effect of persistent anxiety measured prior to an event on LOS and length of stay in the critical care units in patients admitted for ACS events after controlling for demographic and clinical variables.

Specific aim one was address by a systematic review of the literature in which anxiety was causally linked with autonomic control of the heart and subsequent dysrhythmeogensis. The remaining specific aims were addressed by three studies conducted on existing data sets. The first was a prospective, cross-sectional, multi-center study of 536 patients with ACS to test the reliability and validity of the Brief Symptom Inventory. A cross-sectional design was used in the second study to compare the number of complications and LOS in 322 patients with ACS who received Metoprolol during hospitalization. The third was a prospective multi-center study was conducted on 101 patients with ACS to check the effect of persistent anxiety on complication and LOS. The results supported the reliability and validity of the Brief Symptom Inventory as a measure of anxiety in patients hospitalized for ACS. Patients with higher anxiety scores had more complications and longer LOS in the hospital. However, this relationship was not significant for the LOS in the critical care units. The administration of beta-blockers did not eliminate this relationship. Patients with persistent anxiety had more complications, however this relation was not significant in regard to LOS.