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Title: The relationship between phobic anxiety and 2-year readmission after Acute Coronary Syndrome: What is the role of heart rate variability?
Austin Authors: O'Neil, Adrienne;Taylor, C Barr;Hare, David L ;Thomas, Emma;Toukhsati, Samia R ;Oldroyd, John;Scovelle, Anna J;Oldenburg, Brian
Affiliation: Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207, Bouverie St., Parkville, Melbourne, Victoria, Australia
Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
Federation University Australia, School of Health and Life Sciences, Berwick, VIC Australia
Department of Psychiatry, Stanford and Palo Alto Universities, Palo Alto, CA, United States
Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia
Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207, Bouverie St., Parkville, Melbourne, Victoria, Australia
School of Medicine, University of Melbourne Parkville, Melbourne, Victoria, Australia
Issue Date: 15-Mar-2019 2018-12-25
Publication information: Journal of affective disorders 2019; 247: 73-80
Abstract: Phobic anxiety is a risk factor for poor prognosis following Acute Coronary Syndrome (ACS). A psychophysiological marker of vagal function, autonomic dysfunction may play a critical role in this relationship. The aim of the study was two-fold: to assess whether phobic anxiety was characterised by autonomic dysfunction (heart rate variability) in the short (1-month) and longer term (12-months) following ACS, and (ii) to quantify the extent to which HRV parameters modified the effect of phobic anxiety on all-cause hospital readmission over 2 years. The ADVENT study followed 416 ACS patients. At 1-month following discharge (T0), phobic anxiety and autonomic functioning were assessed using the Crown Crisp Index (CCI) and 11 indices of heart rate variability (HRV), respectively. HRV was measured again at 12-months (T1) (n = 359). Hospital readmission (all cause) was derived from an audit of hospital records by two medically trained research fellows. Generalised linear modelling (GLM) was used to first determine the association between CCI score at T0 and HRV parameters at T0 and T1. Binary logistic regression was used to measure the relationship between CCI scores and readmission (yes/no) and the extent to which HRV parameters modified this effect. CCI scores were associated with 7 of the 11 indices of HRV: Average RR (ms), SDRR (ms), RMSSD (ms), SDSD (ms), pRR50 (%), LF Powers (ms2) and HF Powers (ms2) at T0 but not T1. CCI scores at T0 significantly predicted likelihood of readmission to hospital in the subsequent 2 year period. No parameter of HRV at T0 modified this effect. We were unable to provide adjudicated major adverse coronary events outcome data, or account for changes in medication adherence, diet or physical activity. While phobic anxiety is associated with both reduced vagal function in the short term after an ACS event and 2 year all cause readmission, HRV does not appear to be the pathway by which phobic anxiety drives this outcome.
DOI: 10.1016/j.jad.2018.12.078
PubMed URL: 30654268
Type: Journal Article
Subjects: Acute coronary syndrome
Heart rate variability
Vagal function
Appears in Collections:Journal articles

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