Post-attack anxiety dangers.

Patients who experience less anxiety in the first 48 hours after a heart attack may suffer fewer serious complications later. In a study of patients who had acute myocardial infarctions, researchers found that those who became very anxious in the early hours after the heart attack were almost five times more likely to develop serious complications as patients who were less anxious. These results held true regardless of the patients'social or demographic characteristics or severity of heart attack -- factors thought to influence the incidence of complications.

"Anxiety is a common and expected reaction to the many threats associated with an acute myocardial infarction," notes Debra K. Moser, assistant professor of nursing, Ohio State University. "However, even normal anxiety has the potential to cause negative physiologic consequences. The results of this study suggest that anxiety early after a heart attack is associated with increased risk of complications."

For their study, Moser and Kathleen Dracup, professor of nursing, University of California, Los Angeles, assessed the anxiety levels of 86 heart attack patients 48 hours after they arrived in the hospital. All were pain-free and stable at the time of the anxiety assessment, which was done using a standard, brief questionnaire.

The researchers compiled information about the patients' history of heart disease, severity of heart attack, and symptoms of heart failure, as well as their sex, age, marital status, income, and education level. They then monitored the patients for evidence of post-heart-attack complications -- defined as a new bout of poor blood flow to the heart (ischemia), dangerously un-even heart beat (ventricular fibrillation), another heart attack, or in-hospital death. The results:

* Twenty-six percent scored at or above the anxiety level generally found among psychiatric inpatients.

* The high- and low-anxiety groups were...