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Cognitive/behavioral therapy of anxiety in the medically ill: cardiac settings
1Division of Consultation/Liaison Psychiatry, Henry Ford Health Sciences Center, Detroit, MI 48202, USA.
Insights
Anxiety is a significant risk factor for ischemic heart disease (IHD). While no trials prove anxiety reduction improves cardiac outcomes, cognitive behavioral therapy shows promise for chest pain in cardiac patients.
Area of Science:
- Cardiology
- Psychiatry
- Behavioral Medicine
Background:
- Anxiety is a recognized risk factor for ischemic heart disease (IHD), including fatal IHD.
- Anxiety symptoms frequently occur in cardiac patients, negatively impacting quality of life and increasing healthcare utilization.
- Chest pain, a common symptom of IHD, also presents as "noncardiac" chest pain in patients with and without coronary disease.
Purpose of the Study:
- To highlight the lack of randomized controlled trials assessing anxiety interventions' impact on objective cardiac outcomes.
- To discuss the diagnostic and therapeutic challenges of managing anxiety in cardiac populations due to overlapping symptoms and organic causes.
Main Methods:
- Review of existing literature on anxiety as a risk factor for IHD.
- Analysis of treatment responses for chest pain in cardiac and non-cardiac populations.
- Consideration of cognitive/behavioral therapy and pharmacotherapy (imipramine) for chest pain management.
Main Results:
- No randomized controlled trials currently exist to demonstrate that targeting anxiety improves objective cardiac outcomes.
- Cognitive/behavioral therapy has shown efficacy in treating chest pain, irrespective of underlying coronary disease.
- Imipramine is effective for chest pain not associated with coronary disease.
Conclusions:
- Anxiety's role in IHD necessitates further research, particularly randomized controlled trials focused on cardiac outcomes.
- The overlap between anxiety and IHD symptoms requires careful diagnostic evaluation in cardiac patients.
- Effective management strategies for anxiety in cardiac populations are crucial for improving patient care and outcomes.
Abstract:
Anxiety appears to be a strong risk factor for ischemic heart disease (IHD) and specifically fatal IHD. However, no randomly assigned, controlled, clinical trial targeting anxiety yet exists demonstrating an impact on objective cardiac outcomes. Situational anxiety is frequent in cardiac populations and can diminish quality-of-life by increasing symptoms/disability and result in unnecessary medical system utilization. "Noncardiac" chest pain is common both in patients with objective coronary disease and in patients whose cardiac workup is negative. Both presentations of chest pain respond to cognitive/behavioral therapy, and imipramine has been found to be effective for chest pain unaccompanied by coronary disease. Because anxiety-like symptoms overlap with symptoms of IHD (eg, chest pain, dyspnea, dizziness, palpitations) and can be caused by organic factors, the diagnosis and treatment of anxiety in these populations require special considerations.