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Treating anxiety in MI patients.

The article about using the Brief Symptom Inventory to diagnose anxiety in myocardial infarction patients was interesting, but Mohannad Abu Ruz reached conclusions beyond the facts presented ("Brief Questionnaire Identifies MI Patients Needing Anxiety Treatment," Feb. 1, 2006, p. 16).

The low threshold for establishing anxiety included 262 of 536 patients (49%). The patients diagnosed as anxious are shown to have higher complication rates than those of the nonanxious patients, and Mr. Abu Ruz goes on to say that anxiety is an independent risk factor in leading to complications. But then he asserts that the anxious patients should receive diazepam for 3 days (or until discharge from the ICU).

This is a leap beyond the evidence. Perhaps the anxiety leads to complications and benzodiazepines would improve the patient's outcome. But another theory is that the anxiety is a marker of catecholamine surge and complications, and treatment with more [beta]-blockers would improve outcome. Or perhaps by the time the patient is anxious, the organ damage that the anxiety is paralleling has already happened and extra [beta]-blockers are too late.

Using anxiety as a marker for poor outcomes and trying different added treatments should be done in future research. New treatment recommendations are not yet reasonable.

Rex Moss, M.D.

Oakdale, Conn.

Dr. Moss is on the speakers' bureau for Sanofi-Aventis.

Mr. Abu Ruz could not be reached for a reply.

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Title Annotation:Letters
Author:Moss, Rex
Publication:Family Practice News
Article Type:Letter to the editor
Date:Jul 15, 2006
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