Table_3_Heart-Focused Anxiety Affects Behavioral Cardiac Risk Factors and Quality of Life: A Follow-Up Study Using a Psycho-Cardiological Rehabilitation Concept.pdf

BackgroundHeart-focused anxiety (HFA) raises the risk for adverse outcomes in patients with heart disease. Despite this great importance, it is rarely assessed in clinical practice. Three dimensions are commonly defined in the context of HFA: heart-related fear, avoidance, and attention. The impact of these aspects on cardiac risk factors is essentially unclear. In this study, we investigated the relationship between HFA and behavioral cardiac risk factors as well as health-related quality of life (HRQoL), which represent important treatment outcomes of inpatient psycho-cardiological rehabilitation.
MethodsA prospective observational design was used to examine 238 rehabilitation inpatients with comorbidity of cardiac disease and psychiatric disorder. We assessed HFA using the Cardiac Anxiety Questionnaire (CAQ), HRQoL using the SF-12 Health Survey, exercise capacity using the 6-minute walk test, and smoking behavior, respectively at admission (t0) and discharge (t1). Physical activity was assessed at t0 and in a follow-up survey 6 months after discharge (t2) using the International Physical Activity Questionnaire (IPAQ). Multiple regression models were used to analyze the predictive value of HFA for the outcome variables at t0, t1, and t2, adjusted for socio-demographic factors and depression. Predictive values for changes over time were evaluated by the regressor variable approach.
ResultsExercise capacity and physical activity were negatively predicted by baseline heart-related avoidance, both cross-sectionally and prospectively. Avoidance at t1 also negatively predicted long-term changes over time in physical activity at t2. Total HFA and the subcomponent avoidance negatively predicted physical HRQoL both cross-sectionally and prospectively. Mental HRQoL was cross-sectionally predicted by heart-focused attention at t0, and prospectively predicted by total HFA and by avoidance. Regarding changes in the course of rehabilitation, baseline avoidance negatively predicted improvement in physical HRQoL during rehabilitation. Concerning smoking behavior, no associations with HFA were found.
ConclusionsHFA is a relevant inhibiting factor for the achievement of therapy goals in psycho-cardiological rehabilitation such as health behavior and HRQoL. Heart-related avoidance in particular, has a negative impact on exercise capacity, physical activity, and self-reported physical health. Its prospective negative predictive value for physical activity and physical health underlines the relevance of HFA for psycho-cardiological interventions.

研究背景：心脏聚焦型焦虑（Heart-focused Anxiety, HFA）会增加心脏病患者出现不良预后的风险。尽管其临床意义重大，但在实际临床工作中却极少被评估。目前学界通常将HFA划分为三个维度：心脏相关恐惧、回避行为与注意力偏向，但这些维度对心脏危险因素的影响目前尚不明晰。本研究旨在探讨HFA与行为性心脏危险因素以及健康相关生活质量（Health-related Quality of Life, HRQoL）之间的关联，而上述二者均为住院心脏心理康复的重要治疗结局指标。
方法：本研究采用前瞻性观察性研究设计，纳入238名合并心脏病与精神疾病的康复住院患者。我们分别于入院时（t0）与出院时（t1）两个时间点，通过心脏焦虑问卷（Cardiac Anxiety Questionnaire, CAQ）评估患者的HFA水平，通过SF-12健康调查量表评估HRQoL，通过6分钟步行试验（6-minute Walk Test）评估运动能力，并评估吸烟行为。此外，我们于t0以及出院后6个月的随访调查（t2）中，采用国际体力活动问卷（International Physical Activity Questionnaire, IPAQ）评估患者的体力活动水平。本研究采用多元回归模型，在校正社会人口学因素与抑郁症状的前提下，分析HFA对t0、t1、t2各结局变量的预测价值；同时采用回归变量法，评估HFA对随时间变化的结局指标的预测价值。
结果：基线水平的心脏相关回避行为在横断面与前瞻性分析中均对运动能力与体力活动存在负向预测作用。t1时的回避行为同样对t2时的体力活动长期变化存在负向预测作用。总体HFA及其回避维度在横断面与前瞻性分析中均对躯体健康相关生活质量存在负向预测作用。t0时的心脏聚焦型注意力偏向可横断面预测心理健康相关生活质量，而总体HFA与回避行为则可前瞻性预测该指标。针对康复过程中的变化情况，基线回避行为可负向预测康复期间躯体健康相关生活质量的改善程度。而就吸烟行为而言，未发现其与HFA存在显著关联。
结论：HFA是阻碍心脏心理康复中健康行为与HRQoL等治疗目标达成的重要抑制因素。其中尤以心脏相关回避行为最为显著，其对运动能力、体力活动以及自我报告的躯体健康状况均存在负面影响。其对体力活动与躯体健康的前瞻性负向预测价值，进一步凸显了HFA在心脏心理康复干预中的临床相关性。