Abstract
BackgroundThe clinical presentation of panic disorder and panic attack overlaps many symptoms typically experienced in coronary heart disease (CHD). Etiological links between panic disorder and CHD are controversial and remain largely tenuous. This systematic review aims to pool together data regarding panic disorder with respect to incident CHD or myocardial infarction.Methods/DesignElectronic databases (MEDLINE, EMBASE, PsycINFO and SCOPUS) will be searched using a search strategy exploding the topics for CHD and panic disorder. Authors and reference lists of included studies will also be contacted to identify additional published and unpublished studies. Eligibility criteria are as follows: Population: persons without CHD who meet criteria for panic disorder, panic attack, anxiety neurosis or elevated panic disorder symptoms; Comparison: persons without CHD who do not meet criteria for panic disorder, panic attack, anxiety neurosis or elevated panic disorder symptoms; Outcome: verified fatal and non-fatal CHD at follow-up; including coronary revascularization procedure, coronary artery disease, and myocardial infarction. Studies adopting self-report CHD will be ineligible. Screening will be undertaken by two independent reviewers with disagreements resolved through discussion. Data extraction will include original data specified as hazard ratios, risk ratios, and original cell data if available. Risk of bias assessment will be undertaken by two independent reviewers. Meta-analytic methods will be used to synthesize the data collected relating to the CHD outcomes with Cochrane Review Manager 5.3.DiscussionThis systematic review aims to clarify whether panic disorder is associated with elevated risk for subsequent CHD. An evaluation of the etiological links between panic disorder with incident CHD might inform evidence-based clinical practice and policy concerning triaging chest pain patients, diagnostic assessment, and psychiatric intervention with panic disorder patients.Systematic review registrationPROSPERO CRD42014014891.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0026-2) contains supplementary material, which is available to authorized users.
Highlights
The clinical presentation of panic disorder and panic attack overlaps many symptoms typically experienced in coronary heart disease (CHD)
This systematic review aims to clarify whether panic disorder is associated with elevated risk for subsequent CHD
This systematic review aims to add to the extant literature by aggregating data concerning the risk of incident CHD attributable to panic disorder in persons originally free from CHD
Summary
The proposed review may be limited by the pooling together of panic disorder studies with varying levels of validity and heterogeneity. A related limitation concerns the CHD endpoints, and it is possible that different studies will utilize varying methods to determine CHD status at follow-up, each with varying levels of validity and conclusiveness. This limitation is important in our proposed review’s context since that we are largely assessing etiological links assuming that panic precedes CHD, when it is plausible that panic is merely a manifestation of undiagnosed cardiovascular dysfunction, coronary spasm, or sub-clinical CHD. PJT, GAW, DAT, JFB, JDH, SC, and HB contributed to the design of this systematic review.
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