Cardiac disease is the leading cause of death and functional impairment in North America. Cardiac rehabilitation (CR) significantly improves health outcomes, yet adherence to treatment is a major obstacle for this population. Psychosocial factors such as depression have been identified as barriers to rehabilitation attendance, but evidence for anxiety as a potential barrier has been inconsistent. The aim of the current study was to test a more specific type of anxiety, heart-focused anxiety, as a predictor of CR attendance. Thirty-two participants between 39 and 87 years of age (M = 63.66, SD = 12.54, 53.1% female) were recruited from the Loma Linda University Medical Center CR program and heart clinic. Participants were given a psychological battery in which heart-focused anxiety, general anxiety, and depression were assessed. Two hierarchical binomial logistic regression models were run to test whether heart-focused anxiety predicted CR attendance above and beyond the influence of demographic variables, depression, and general anxiety. None of the predictors were statistically significant due to small sample size, therefore effect sizes were interpreted. In the first model, results indicated that there was a 35.7% increase in the odds of CR attendance for female participants (OR = 1.357, p > .7), a 32.9% increase in odds of attendance for every one-point increase in general anxiety (OR = 1.329, p > .1), and a 7.8% decrease in odds of attendance with every one-point increase in overall cardiac anxiety (OR = .922, p > .8). In the second model, subscales of heart-focused anxiety were separated. Results indicated that the odds of attending CR increased by 60.7% for each one-point increase on the Fear subscale of the CAQ, increased by 34.3% for each one-point increase on the Avoidance subscale (OR = 1.343, p > .7), and decreased by 57.3% for every one-point increase on the Attention subscale (OR = .427, p > .2). Results suggest that patients with higher general anxiety, fear, and avoidance are more likely to attend CR (group 1), while those with higher levels of heart-focused anxiety and avoidance are less likely to attend CR (group 2). These findings suggest that patients in group 1 may benefit from standard interventions, such as increased educational counseling about their treatment and adherence, and patients in group 2 may benefit from interventions to reduce anxiety.

LLU Discipline

Clinical Psychology




School of Behavioral Health

First Advisor

Morrell, Holly E. R.

Second Advisor

Houston-Feenstra, Linda

Third Advisor

Owen, Jason E.

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Anxiety Disorders; Heart Failure; Myocardial Infarction; Psychometrics; Psychology

Subject - Local

Cardiac Rehabilitation; Depression; Rehabilitation Attendance; Hierarchical Binomial Logistic Regression Models



Page Count


Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives