Open Access, Peer-reviewed
eISSN 2093-758X
    J Korean Acad Nurs. 2011 Oct;41(5):704-714. Korean.
    Published online Oct 31, 2011.
    https://doi.org/10.4040/jkan.2011.41.5.704
    © 2011 Korean Society of Nursing Science
    Original Article

    A Systematic Review of Psychological Distress as a Risk Factor for Recurrent Cardiac Events in Patients with Coronary Artery Disease

    Jin-Hee Park,1 and Sun Hyoung Bae2
      • 1Assistant Professor, College of Nursing, Ajou University, Suwon, Korea.
      • 2Doctoral student, College of Nursing, Yonsei University, Seoul, Korea.
    • Address reprint requests to: Bae, Sun Hyoung. Doctoral student, College of Nursing, Yonsei University, San 5 Wonchon-dong, Yeongtong-gu, Suwon 443-721, Korea. Tel: +82-31-219-7019, Fax: +82-31-219-7020, Email: baega7695@hanmail.net
    Received January 10, 2011; Accepted October 24, 2011.

    Abstract

    Purpose

    The purpose of this study was to determine whether psychological distress is an independent risk factor for recurrent cardiac events in patients with coronary artery disease (CAD).

    Methods

    A prospective cohort of studies that measured psychological distress and the incidence of recurrent cardiac events in the adult population were included. Three computerized databases were assessed (PubMed, CINAHL, and PSYCINFO). Meta-analysis was conducted using a random-effects model to determine summary estimates of risks of major recurrent cardiac events associated with each psychological distress. Of 506 publications identified, 33 met inclusion criteria, and 24 studies were used to estimate effect size of psychological distress on recurrent cardiac events.

    Results

    Mean number in the research sample was 736 and mean time of follow-up was 4.0 years. Depression, anxiety, anger, and hostility as psychological factors were studied. According to estimation of effect size using random model effect, depression (OR=1.39, 95% CI: 1.22-1.57), anxiety (OR=1.22, 95% CI: 0.96-1.56), and anger/hostility (OR=1.29, 95% CI: 1.07-1.57) CAD patients in significantly increased risk for recurrent cardiac events.

    Conclusion

    Finding suggests that psychological distress in forms of depression, anxiety, anger, and hostility impact unfavorably on recurrent cardiac events in CAD patients.

    Keywords
    Psychological stress; Prognosis; Recurrence; Mortality; Coronary artery disease

    Figures

    Figure 1
    Flow diagram of study screening.

    Figure 2
    Psychological distress as a risk factor for recurrent cardiac events.

    Figure 3
    Funnel plot of selected studies for effect size extraction. A=Depression; B=Anxiety; C=Anger and hostility.

    Tables

    Table 1
    Results of the Quality Assessment of Selected Studies (N=33)

    Table 2
    Characteristics Presented in 33 Studies (N=33)

    Table 3
    Characteristics of Selected Studies for Effect Size Extraction (N=24)

    Notes

    This work was supported by the National Research Foundation of Korea (KRF) funded by the Korea government (MEST) (2009-0065948).

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