Management of anxiety after acute myocardial infarction

Anxiety is common after acute myocardial infarction (AMI) and may induce complications and poorer outcome because of activation of the sympathetic nervous system and the hypothalamic pituitary adrenal axis. Little is known about critical care nurses' management of anxiety in the initial days after AMI.

The purpose of this study was to describe pharmacological and nonpharmacological anxiety management practices in a sample of patients with AMI and to determine the association between patient self-reported anxiety level, clinician anxiety assessment, and subsequent anxiety management by clinicians.

In this descriptive, correlational investigation, subjects (n = 101) were requested to complete the Spielberger State Anxiety Inventory (SAI) within 48 hours of hospital admission for AMI. After hospital discharge, the investigators performed a thorough medical records review to evaluate the use of pharmacological and nonpharmacological anxiety management strategies for the period that encompassed 12 hours before and 12 hours after administration of the SAI.

Subjects were primarily white (93%), married (72%) individuals with a hospital admission Killip classification of I (71%). Documentation of subjective anxiety assessment was found for only 45 subjects (44.6%). Subject rating of anxiety with SAI ranged from 20 (no anxiety) to 77 (extreme anxiety; mean, 37.2 +/- 12.4). Seventy-two subjects had documentation of anxiety management (pharmacological, 25.7%; nonpharmacological, 45.6%). No significant relationship was seen between the subject SAI score and the clinician assessment of anxiety (lambda = 0.03; P < .05). Although documentation was seen that 72 subjects received anxiety management, no association was found between the clinician evaluation of anxiety and the use of anxiety management strategies (pharmacological: lambda = 0.11; P = .65; nonpharmacological: lambda = 0.07; P = .08). A small but significant relationship was found between the subject SAI score and the use of pharmacological anxiety management (lambda = 0.10; P = .03) but no association was found between SAI score and the use of nonpharmacological anxiety management (lambda = 0.6; P = .50). Evaluation of efficacy was not routinely documented (pharmacological, 58%; nonpharmacological, 2%). Only 2 subjects (2%) received consultation to social work for management of anxiety.

Anxiety was not systematically and accurately assessed or logically managed in this sample of patients with AMI. Critical care clinicians need a comprehensive understanding about the importance of anxiety to patient outcome in addition to objective, reliable, and valid anxiety measures and a useful repertoire of evidence-based management strategies to effectively manage anxiety. Effective management of anxiety positively influences patient outcome and should be a goal for all critical care patients.