Elsevier

Heart & Lung

Volume 40, Issue 3, May–June 2011, Pages 185-192
Heart & Lung

Care of Patients with Coronary Heart Disease
Anxiety in patients undergoing percutaneous coronary interventions

https://doi.org/10.1016/j.hrtlng.2010.05.054Get rights and content

Abstract

Objective

Many patients undergoing percutaneous coronary intervention (PCI) experience symptoms of anxiety; however, it is unclear whether anxiety is an issue in the early recovery period and the types of factors and patient concerns that are associated. This study set out to determine the patterns of anxiety and concerns experienced by patients undergoing PCI and the contributing factors in the time period surrounding PCI.

Methods

A convenience sample of patients undergoing PCI (n = 100) were recruited, and anxiety was measured using the Spielberger State Anxiety Inventory immediately before the PCI, the first day postprocedure, and 1 week postdischarge. Patients were also asked to identify their most important concern at each time. Independent predictors of anxiety at each time were determined by multiple regression analysis.

Results

Anxiety scores were highest pre-procedure (35.72, standard deviation [SD] 11.75), decreasing significantly by the postprocedure time (31.8, SD 10.20) and further still by the postdischarge time (28.79, SD 9.78) (repeated-measures analysis of variance: F = 39.72, P < .001). The concerns patients identified most frequently as most important were the outcome of the PCI and the possibility of surgery pre-procedure (37%) and postdischarge (31%), and the limitations and discomfort arising from the access site wound and immobility postprocedure (25%). The predictor of anxiety at the pre-procedure time was taking medication for anxiety and depression (b = 7.12). The predictors of anxiety at the postprocedure time were undergoing first-time PCI (b = 4.44), experiencing chest pain (b = 7.63), and experiencing pre-procedural anxiety (b = .49). The predictors of anxiety at the postdischarge time were reporting their most important concern as the future progression of CAD (b = 7.51) and pre-procedural anxiety (b = .37).

Conclusion

Symptoms of anxiety were common, particularly before PCI. These symptoms are important to detect and treat because pre-procedural anxiety is predictive of anxiety on subsequent occasions. Patients who have had chest pain or their first PCI should be targeted for intervention during the early recovery period after PCI, and information on CAD should be provided postdischarge.

Section snippets

Materials and Methods

The study used a descriptive design with measures repeated immediately before the PCI procedure, the first day postprocedure, and 1 week postdischarge. Approval was granted by the ethics committee of all institutions involved before its implementation.

Sample Characteristics

The sample participants had an average age of 65.63 years, most were male (80%), and 83% of them were married (Table 1). A typical participant had 1 vessel treated (70%) and received only 1 stent (54%) as opposed to multiple stents. Complications were experienced by 30% of participants, of which chest pain was the most common both postprocedure (9%) and postdischarge (31%). A small proportion (3%) experienced a myocardial infarction after discharge and sought emergency department treatment.

Anxiety

Discussion

This study demonstrated that anxiety in patients undergoing PCI is generally mild before the procedure and decreases further after the procedure; however, clinically relevant anxiety was not uncommon. Both before the procedure and after discharge, the most frequent important concern patients expressed was that the PCI may be unsuccessful, resulting in further invasive procedures (eg, coronary artery bypass grafting). This concern was independently associated with anxiety postdischarge.

Strengths and Limitations

A key strength of the study included the use of assessments at key times for patients undergoing PCI, immediately pre-procedure, postprocedure before going home, and during early recovery at home. The use of repeated measures and a sample that completed all 3 assessments was a strength; however, this method reduced the sample size and most likely the explanatory capacity of the regression models. Given the influence of pre-procedure anxiety on subsequent anxiety, it is possible that the

Implications for Nursing Practice

Given the potentially serious consequences of untreated anxiety, the assessment of anxiety is warranted, yet this assessment rarely occurs as a part of routine care.40, 41 Critical care nurses commonly rely on behavioral and physiologic indicators in their clinical evaluations of patients' anxiety,53 although anxiety may not be reflected in these outward signs, so anxiety can be underestimated.40, 41 There is a need to use a straightforward, quick, and reliable anxiety assessment instrument,

Conclusions

Symptoms of anxiety are a significant issue for some patients undergoing PCI, particularly before the procedure, although they are not uncommon across the whole time period; therefore, assessment of anxiety should be a routine component of care for patients undergoing PCI. This assessment would enable nurses to help patients manage anxiety or provide resources for mental health, stress management, or behavioral medicine services. Interventions aimed at managing anxiety need to be tailored to

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