Abstract
When the heart is (thought to be) in danger - like after a myocardial infarction (MI) or in patients with Non Cardiac Chest Pain (NCCP)- , this may provoke specific fears related to the heart: cardiac anxiety. This anxiety is often not acknowledged nor treated. The present thesis showed that cardiac anxiety in fact really matters. Even when other factors are taken into account, like the severity of the heart condition or depression, which has been described previously as relevant in this context. Cardiac anxiety after a heart attack leads to a worse outcome. More anxiety is not only associated with a worse quality of life, but also with poorer physical outcome, i.e. a higher risk of a new heart attack or death. Three independent Dutch samples were used; two cohorts of MI-patients and a sample of NCCP patients who presented themselves at the emergency department and were diagnosed with a panic and/ or depressive disorder. In short, the six studies described in this thesis showed that cardiac anxiety post-MI can be reliably assessed with the self-rated Cardiac Anxiety Questionnaire, that patients report different trajectories of cardiac anxiety over time following a MI, and that higher cardiac anxiety is associated with more general anxiety and depressive symptoms, a worse quality of life one year post-MI, and a worse cardiac prognosis up to five years post-MI. To approximate cardiac anxiety when it is not explicitly assessed, is difficult. Finally, a randomized controlled trial found that Cognitive Behavioral Therapy (CBT) in NCCP-patients with a co morbid panic and/or depressive disorder assumed to suffer from cardiac anxiety can significantly reduce disease severity, anxiety and depressive symptoms. A logical follow-up would be to investigate treatment of cardiac anxiety post-MI.
