Anxiety in patients referred for elective coronary angiography: a prospective cohort study

Medical procedures have the potential to elicit feelings of anxiety, which have been associated with reduced health-related quality of life and cardiac dysfunction. The prevalence of anxiety in patients referred for elective coronary angiography (CA) ranges from 24% to 72%. Anxiety, in combination with coping, was rarely assessed apart from depression in these patients. The aims of this study were to determine the prevalence of anxiety, assess its correlation with coping traits, and with elective CA findings in non-depressed patients.

This was a single-center, prospective cohort study. Anxiety was evaluated: two weeks before, on the day of CA, 24-hours post CA, and one month post CA. Psychological parameters were determined using self-administered questionnaires and anxiety was analyzed on those without depressive symptoms. The association between anxiety and psychological variables was assessed by multiple linear regression and by linear mixed effect model.

Out of 393 patients screened for depression and anxiety, 259 non-depressed patients (age 65 years, 36% women) were analyzed. Anxiety was present in 91/259 (35%) of patients. Avoidance-oriented coping was a significant predictor of higher trait anxiety (p < 0.001) and lower state anxiety 24-hours post CA. CA indicated no intervention in 183 patients (71%), while revascularization, either percutaneous (49 patients, 19%) or surgical (27 patients, 10%), was performed in the remaining patients. Anxiety decreased between the baseline and all subsequent time points (p < 0.001) in all groups.

More than one third of non-depressed patients experience clinically significant anxiety before CA. Avoidance-oriented coping has a significant impact on anxiety. The findings of our study suggest the routine screening for anxiety and coping strategies prior to elective CA might be helpful to identify those individuals who are in need for additional psychological interventions.

The study was registered at ClinicalTrials.gov (NCT02804009).