A heart attack can make anyone anxious, but women experience greater anxiety than men do after heart attacks, a pattern that is consistent across four continents, a new study notes.

The higher level of anxiety among women is not connected to geography, to demographic factors like marital status and education or to medical condition, according to a report published in the July issue of Psychosomatic Medicine.

Anxiety - the emotional response to a threat - may be an expected and common psychological reaction to a heart attack, but its effects go beyond the patient's mood, say Debra K. Moser, R.N., D.N.Sc., and colleagues. People with higher anxiety levels also have higher levels of complications in the hospital, like second heart attacks, blood vessel blockages, irregular heartbeat and death.

To learn more about the gender differences in anxiety after heart attacks, Moser, a professor of nursing at the University of Kentucky, and her international team recruited 912 patients from Australia, England, Japan, South Korea and the United States.

Each patient answered a short, six-question test which reliably measures anxiety. The standard score for non-patients is 0.35 and for psychiatric inpatients it's 1.5. When tested within 72 hours of their heart attacks, women in the study scored an average of 0.76 on the scale while men scored 0.57.

Moser says that difference was enough to see variations between men and women in the medical complications they experienced. And, she notes, that relationship held regardless of where patients lived.

"There were no statistically significant differences in anxiety among the countries," she says. "Women from a variety of cultural backgrounds have higher levels of anxiety than men, and the threatening nature of a heart attack produces anxiety regardless of the patient's cultural background."

This finding confirmed earlier studies that showed no wide cross-cultural differences in the presence of depression and anxiety disorders. However, the researchers also found that both men and women under age 60 reported higher levels of anxiety than those older than 60.

"We speculate that this is because older people seem to expect illness, while younger ones who are often still working and who consider themselves healthy do not," says Moser. "This is just speculation, but seems consistent with some other findings."

The effect of anxiety on a patient's survival after a heart attack is important enough that health care providers should consider it in treating their patients, Moser says.

"All patients should receive adequate assessment and management of their anxiety, but it is important for clinicians to recognize those groups of patients - such as women - who are at greater risk for higher anxiety," she says.

The study was supported by the American Association of Colleges of Nursing Sigma Theta Tau Research Grant, the Bennett-Puritan AACN Mentorship; Sigma Theta Tau; and the Pacific Rim Grant.

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