Understanding anxiety following myocardial infarction

Introduction. Anxiety is highly prevalent following myocardial infarction (MI) and is linked with adverse effects on a person’s physical recovery, return to work, social engagement, quality of life, and can lead to an increased risk of future cardiac events and mortality. The overarching aim of the research described in this thesis was to deepen our understanding of anxiety following MI. More specifically, the research aimed to systematically identify and synthesise empirical evidence regarding the effectiveness of psychological interventions for anxiety following MI (Study 1) and further empirical knowledge in relation to the personal experience of coping with anxiety post-MI (Study 2).

Methods. For the systematic review (Study 1), seven databases were searched for peer-reviewed literature that provided information on anxiety pre and post psychological intervention following a MI. Eighteen articles were identified for inclusion in the review. A narrative synthesis was performed to synthesise the findings of these studies. For the qualitative interview study (Study 2), eight participants who experienced a MI and presented with self-reported anxiety engaged in an online screening questionnaire and an individual semi-structured interview on their experience of coping with anxiety post-MI. Interpretative phenomenological analysis (IPA) was used to analyse the data.

Results. The findings of Study 1 indicated that psychological interventions have the potential to decrease anxiety symptoms following a MI. Ten studies reported a significant decrease in anxiety following a psychological intervention, when compared to usual care. Three studies noted mixed results and five studies reported no significant difference in anxiety following a psychological intervention post-MI. No particular type of psychological intervention appeared superior to others. Study 2 outlined how the traumatic nature of a MI can result in anxiety that affects people’s sense of safety and how they live their day-to-day lives. Participants’ reported MI-related anxiety resulted in a need for effective coping mechanisms to manage their symptoms. Four major themes were developed based on the research question: Using Actions

That ‘Work’, Safety Behaviours, Leaning On Others, and The Role Of Work

Conclusions. Anxiety symptoms following a MI are common and can have a detrimental impact on a person’s recovery, quality of life, physical health, and life expectancy. This thesis offers insight into the experience of anxiety following a MI and how healthcare professionals can support people within this experience. Assessing and treating anxiety should be an important factor within a person’s MI recovery. It is apparent psychological interventions can alleviate anxiety post-MI; however, more research is needed to identify the type of psychological intervention(s) that are most effective in addressing anxiety symptoms. Results from Study 2 suggest that acknowledging and understanding anxiety, identifying effective personal strategies, and seeking support from others can help individuals cope with their anxiety. Going forward, more rigorous research is needed surrounding anxiety and MI; with both studies providing a necessary map for future research in this area.