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Explain to interested patients that this study suggested pharmacologic treatment with anxiolytics as well as patient education and other nonpharmacologic means may help reduce anxiety from medical procedures and acute illness.

The study by Debra K. Moser, D.N.Sc., M.N., R.N., of the University of Kentucky in Lexington, and colleagues measured anxiety in 879 acute MI patients in the United States, Australia, England, Japan, and South Korea.

Within 48 hours of admission, women had almost 25% higher anxiety scores than men on the anxiety subscale of the Brief Symptom Inventory administered, Dr. Moser said. The typical score in these patients was about twice the cutoff for high anxiety (0.66 versus 0.33) but not as high as is seen in psychiatric patients being treated for anxiety (typically 1.7 on the four-point scale).

Even after adjusting for a variety of factors, anxiety significantly predicted complications (odds ratio 1.23, 95% confidence interval 1.04 to 1.47, P=0.019), indicating that anxiety is an important factor for both genders.

However, the combination of gender and anxiety was a stronger predictor of in-hospital complications following acute MI (OR 1.33, 95% CI 1.01 to 1.74, P=0.04).

Previous studies have indicated that women have higher morbidity and mortality soon after an acute MI. To help explain this phenomenon, researchers blinded to the patients' anxiety level assessed complication rates by "extensive" chart review.

In-hospital complications were defined as reinfarction, recurrent ischemia, malignant dysrhythmias, cardiogenic shock, and acute heart failure. The patients' mean age was 61, and 28% were women.

The investigators found that roughly twice as many women as men had high anxiety using a cutoff score of 0.33. And, the in-hospital complication rate was significantly higher among women as well (30.4% versus 22% for men, P=0.008).

Anti-anxiety medications -- such as Xanax (alprazolam), Valium (diazepam), and benzodiazepines -- were associated with as much decrease in complications as fibrinolytics (OR 0.492, 95% CI 0.35 to 0.68, P=0.001, versus OR 0.70, 95% CI 0.50 to 0.97, P=0.03).

"Treating anxiety with anxiolytics is important to consider in reducing complications and deaths," said Dr. Moser.

There is such an emphasis on timely treatment for heart attack patients that healthcare professionals often do not ask patients about anxiety levels, commented Ann Bolger, M.D., of the University of California San Francisco, who was uninvolved in the study.

"You don't have to give a pill in every case," Dr. Bolger said. Sometimes simply having a nurse talk the patient through the process may reduce anxiety, she added.

Other independent predictors of in-hospital complications included being a current smoker (OR 1.61, 95% CI 1.15 to 2.24, P=0.005) and Killip classification I at admission to the hospital (OR 0.50, 95% CI 0.36 to 0.70, P=0.001).

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