Association between acute symptom burden and anxiety symptoms after myocardial infarction

Prevalence estimates for anxiety after acute myocardial infarction (AMI) range from 12% (formal diagnoses) to 38% (self-reported symptoms). Many patients perceive an AMI as a life-threatening event. Acute chest pain, pain in other areas, and several vegetative symptoms can occur. The aim was to investigate the association between the symptoms during AMI and anxiety symptoms afterwards.

Data from 994 AMI survivors enrolled in the Myocardial Infarction Registry Augsburg, assessing 12 acute symptoms and anxiety symptoms at a mean follow-up of 12.4 months using the Generalized Anxiety Disorder-7 questionnaire (GAD-7) were analyzed. Chest pain, pain in other areas (left or right arm, between shoulder blades, upper abdomen, jaw), dyspnea, vertigo, sweating, nausea, syncope, and fear of death were assessed. Multivariable linear regression models were calculated to analyze the association between symptoms at the acute event and anxiety symptoms at follow-up.

Ninety-five (9.6%) participants reported clinically relevant symptoms of anxiety (GAD-7 ≥ 10). Having ≥5 symptoms (compared to 0-2 symptoms) during AMI was positively associated with anxiety symptoms (β = 0.96, p-value =0.004) after the event. Having three or more non-typical pain symptoms (β = 2.18, p-value <0.001) and having three or more vegetative symptoms (β = 1.18, p-value = 0.006) was positively associated with anxiety symptoms (reference: no non-typical pain or vegetative symptoms).

A greater number of symptoms occurring during AMI, particularly non-typical pain and vegetative symptoms, is associated with elevated anxiety symptoms post-AMI. These findings need confirmation but highlight the importance of monitoring mental health in patients presenting with diverse symptom profiles after AMI.