Gender differences in the associations between anxiety early after acute myocardial infarction and subsequent in-hospital complications

详细信息   

• 作者：Kim ; Kyungeh An
• 学历：Doctor
• 年：1999
• 关键词：Health and environmental sciences ; Social sciences
• 导师：Moser,Debra K
• 毕业院校：Ohio State University
• 专业：Nursing;Social psychology;Womens studies;Physiological psychology;Anxieties;Heart attacks
• ISBN：0599429003,9780599429000
• CBH：9941360
• Country：USA
• 语种：English
• FileSize：8295525
• Pages：225

文摘

Acute myocardial infarction (AMI) is defined as irreversible necrosis of myocardial tissue caused by inadequate blood flow to the myocardium for a critical period of time. This process is responsible for significant morbidity and mortality in the United States and worldwide. In-hospital complications are often associated with in-hospital and one year mortality after AMI. Among numerous factors that affect in-hospital complications and subsequent mortality,anxiety may play an important role by exaggerating sympathetic activity that mediates ischemic and arrhythmic cardiac events. It has been controversial whether women experience higher anxiety than men do and whether anxiety has a greater effect on in-hospital complications in women than in men. A multicenter-prospective study was conducted to examine gender differences in anxiety and in the association between anxiety and subsequent in-hospital complications after AMI. Anxiety was measured within 72 hours after admission using the anxiety dimension of the Brief Symptom Inventory (BSI) and the state anxiety subscale of the State Trait Anxiety Inventory (SAI). In-hospital complications were defined as ventricular tachycardia,ventricular fibrillation,recurrent ischemia,reinfarction or cardiac death. Three hypotheses were tested to determine gender differences in anxiety and in the association between anxiety and in-hospital complications. First,to compare anxiety scores in men and women,independent t-tests were conducted. Women had a significantly higher level of anxiety measured within 72 hours after admission on both the BSI and the SAI scales. Second,anxiety significantly contributed to the prediction of in-hospital complications while traditional risk factors were controlled. Univariate analyses were conducted to identify risk factors for in-hospital complications. Marital status,presence of diabetes,low left ventricular ejection fraction and the high level of the creatinine kinase isoenzyme (CK-MB) were significant predictors of in-hospital complications. A hierarchical logistic regression was conducted to examine the unique contribution of anxiety to the prediction of in-hospital complications. Anxiety significantly contributed to the prediction of in-hospital complications in both men and women. The overall incidence of in-hospital complications was significantly higher in the high anxiety group than in the low anxiety group. Specifically,more subjects in the high anxiety group experienced a single episode of ventricular tachycardia and multiple episodes of ventricular tachycardia. More subjects in the high anxiety group experienced ventricular fibrillation,recurrent ischemia,and reinfarction. Third,the extent to which anxiety added to traditional risk factors in the prediction of AMI complications was significantly higher in women. Women with high anxiety were five times more likely to have overall complications than men with high anxiety following AMI. Findings from this study provide important information about anxiety following AMI. Higher anxiety in women suggested that women might be more vulnerable than men to develop in-hospital complications when they experience an AMI. Single or widowed women especially need more attention due to their higher anxiety and potential subsequent complications. The patterns of anxiety found in this study suggest that anxiety should be assessed early after hospitalization for AMI to prevent its potential effects on development of in-hospital complications. (Abstract shortened by UMI.)