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Depression and Anxiety as Predictors of Recurrent Cardiac Events 12 Months After Percutaneous Coronary Interventions

Park, Jin-Hee PhD, RN; Tahk, Seung-Jea PhD, MD; Bae, Sun Hyoung PhD, RN

Journal of Cardiovascular Nursing: July/August 2015 - Volume 30 - Issue 4 - p 351–359
doi: 10.1097/JCN.0000000000000143

Background: Anxiety and depression are associated with recurrent cardiac events after percutaneous coronary interventions (PCIs). However, few investigators have evaluated the impact of depression and anxiety on recurrent cardiac events in Korea.

Objective: The aim of this study was to examine the relationship among depression, anxiety, and recurrent cardiac events in Korean patients with coronary artery disease (CAD) after PCI.

Methods: A prospective longitudinal study was undertaken with a sample of 133 CAD patients with PCI. Data were collected between August 2009 and September 2010, and patients were followed after discharge through 2011 with self-report questionnaires on anxiety and depression using the Hospital Anxiety and Depression Scale and with patient medical records on sociodemographic and clinical characteristics. Recurrent cardiac events were collected for 12 months after discharge and were assessed by patient interviews and medical records.

Results: There were 18 recurrent cardiac events (13.5%) among the 133 participants. After adjustment for sociodemographic and clinical characteristics, a hierarchical Cox proportional hazards regression model found that a moderate or severe level of anxiety (hazard ratio, 6.21; 95% confidence interval, 1.64–23.54) and a moderate or severe level of depression (hazard ratio, 4.32; 95% confidence interval, 1.35–13.88) were independent predictors of recurrent cardiac events.

Conclusions: Patients with CAD who have a high level of anxiety and depression are at increased risk for recurrent cardiac events after PCI. Screening should be focused on patients who experience anxious and depressive feelings in addition to traditional risk factors. Furthermore, psychoeducational support interventions to reduce anxiety and depression after PCI may improve health outcomes.

Jin-Hee Park, PhD, RN Associate Professor, College of Nursing, Ajou University, Suwon, Gyeonggi-Do, Republic of Korea.

Seung-Jea Tahk, PhD, MD Professor, School of Medicine, Department of Cardiology, Ajou University, Suwon, Gyeonggi-Do, Republic of Korea.

Sun Hyoung Bae, PhD, RN Assistant Professor, College of Medicine, Department of Nursing, Dong-A University, Busan, Republic of Korea.

This work was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2009-0065948).

The authors have no conflicts of interest to disclose.

Correspondence Sun Hyoung Bae, PhD, RN, College of Medicine, Department of Nursing, Dong-A University, Gudeok Campus, Dongdaesin-dong 3(sam)-ga, Seo-gu, Busan, Republic of Korea (

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