Prognostic Value of Anxiety and Depression In Patients With Chronic Heart Failure (original) (raw)
Related papers
2016
Prevalence and variables predictive of depressive symptoms in patients hospitalized for heart failure
Polish Journal of Cardio-Thoracic Surgery, 2014
Despite advances in medicine, chronic heart failure (CHF) still remains a significant clinical problem associated with poor outcome. To determine risk factors for major adverse cardiac events (MACE) in three-year follow-up in patients with CHF of nonischemic etiology. The prospective study included consecutive hospitalized patients with stable CHF (LVEDD > 57 mm; LVEF < 40%) and symptom duration > 6 months. Study exclusion criteria were: serious neurological and/or psychiatric diseases, stenoses in epicardial coronary arteries in coronarography, active myocarditis confirmed by myocardial biopsy, diseases of the respiratory system with pulmonary hypertension, presence of heart defects, neoplastic or connective tissue disease, documented infectious diseases at least three months before inclusion in the study, diabetes, liver cirrhosis, chronic kidney disease (eGFR < 30 ml/min/1.73 m(2)), alcoholism, planned heart transplantation. Depression severity was assessed with the Beck and the Hamilton Scales. Depression was diagnosed based on the ICD-10 criteria. Clinical follow-up began on admission and lasted three years. The analysis encompassed 199 patients aged 49 (41-54), who met the inclusion/exclusion criteria. Depression was diagnosed in 30% of the patients. Independent factors increasing the risk of MACE (death, transplantation, ventricular assist device, hospitalization) were: depression (HR: 2.26; p < 0.001), E/A index (HR: 1.31; p < 0.01), right ventricular dimension (HR: 1.06; p < 0.01), hsCRP level (HR: 1.06; p < 0.01) and alkaline phosphatase activity in blood serum (HR: 1.01; p < 0.05). Factors affecting 3-year outcome are: depression, right ventricular dimension, the E/A index, alkaline phosphatase activity and the level of high-sensitivity C-reactive protein (hs-CRP).
Journal of Cardiac Failure, 2009
Background: Depressive symptoms are risk factors for poor outcomes and are positively associated with disease severity in patients with heart failure (HF). However, little is known about this association in the Japanese population. Therefore, we evaluated the prevalence of depressive symptoms and whether depressive symptoms predicted hospitalization for HF and death independent of disease severity and other factors in HF patients. Methods and Results: A 2-year prospective cohort study was conducted on 115 outpatients with HF (73.9% males; mean age 64.7 years) in Tokyo. Of these, 27 patients (23.5%) were classified as having depressive symptoms (Center for Epidemiologic Studies Depression Scale score $16). Patients with depressive symptoms had higher rates of 2-year cardiac death or HF hospitalization (34.0% vs. 10.3%; P ! .01), HF hospitalization (27.4% vs. 9.2%; P 5 .01), and all-cause death (27.4% vs. 7.2%; P ! .01). Multivariate Cox regression analyses indicated that depressive symptoms were predictors of cardiac death or HF hospitalization (hazard ratio [HR], 3.29; P 5 .02), HF hospitalization (HR, 3.36; P 5 .04), and all-cause death (HR, 5.52; P 5 .01), independent of age and brain natriuretic peptide. Conclusions: Depressive symptoms were common and independent predictors of poor outcomes in Japanese patients with HF. (J Cardiac Fail 2009;15:912e919)
Depression increasingly predicts mortality in the course of congestive heart failure
European Journal of Heart Failure, 2005
Background: Congestive heart failure (CHF) is frequently associated with depression. However, the impact of depression on prognosis has not yet been sufficiently established. Aims: To prospectively investigate the influence of depression on mortality in patients with CHF. Methods: In 209 CHF patients depression was assessed by the Hospital Anxiety and Depression Scale (HADS-D). Results: Compared to survivors (n=164), non-survivors (n=45) were characterized by a higher New York Heart Association (NYHA) functional class (2.8F0.7 vs. 2.5F0.6), and a lower left ventricular ejection fraction (LVEF) (18F8 vs. 23F10%) and peakVO 2 (13.1F4.5 vs. 15.4F5.2 ml/kg/min) at baseline. Furthermore, non-survivors had a higher depression score (7.5F4.0 vs. 6.1F4.3) (all Pb0.05). After a mean follow-up of 24.8 months the depression score was identified as a significant indicator of mortality ( Pb0.01). In multivariate analysis the depression score predicted mortality independent from NYHA functional class, LVEF and peakVO 2 . Combination of depression score, LVEF and peakVO 2 allowed for a better risk stratification than combination of LVEF and peakVO 2 alone. The risk ratio for mortality in patients with an elevated depression score (i.e. above the median) rose over time to 8.2 after 30 months (CI 2.62-25.84). Conclusions: The depression score predicts mortality independent of somatic parameters in CHF patients not treated for depression. Its prognostic power increases over time and should, thus, be accounted for in risk stratification and therapy.
The Determination of Depression and Anxiety Level in Individuals with Chronic Heart Failure
Pakistan Heart Journal, 2021
Objective: This study was planned to assess the depression and anxiety level in individuals with Chronic Heart Failure (CHF). Methodology: A cross sectional study was conducted in a training and research hospital in Istanbul. The population of the study consisted of patients with CHF who stayed in the cardiology and internal medicine clinics between the months of March and June 2017. One hundred consecutive patients of CHF were included in the study. The "Hospital Anxiety and Depression Scale" (HAD) was used to assess the anxiety and depression level of the patients and other demographic and exploratory variables data was collected on a questionnaire. Results: The anxiety and depression was found in 62% and 84%, CHF patients respectively. The anxiety levels were found to be high in the individuals with no social insurance, females, primary school graduates and housewives. Also, the depression levels of the cases whose duration of disease was longer were found to be high. T...
Journal of Cardiology, 2014
Background: Anxiety is often present in patients with depression. The aim of this study was to evaluate the impact of clustered depression and anxiety on mortality and rehospitalization in hospitalized patients with heart failure (HF). Methods: A total of 221 hospitalized patients with HF, who completed the questionnaires, were analyzed in this prospective study (mean age 62 ± 13 years; 28% female). One-third patients had implanted cardiac devices. Depression was defined as a Zung Self-Rating Depression Scale index score of ≥60 and anxiety was defined as a State-Trait Anxiety Inventory score of ≥40 (male) or ≥42 (female). The primary outcome was the composite of death from any cause or rehospitalization due to worsened HF and refractory arrhythmia. Results: Of the 221 HF patients, 29 (13%) had depression alone, 80 (36%) had anxiety alone, and 46 patients (21%) had both depression and anxiety. During an average follow-up of 41 ± 21 months, patients with depression alone and those with clustered depression and anxiety were at an increased risk of the primary outcome [hazard ratio (HR) 2.24, 95% confidence interval (CI): 1.17-4.28, p = 0.01 and HR 2.75, 95% CI: 1.51-4.99, p = 0.01, respectively] compared to patients with no symptoms. Multivariate analysis after adjusting for age, gender, New York Heart Association functional class, B-type natriuretic peptide, device implantation, renal dysfunction, and left ventricular dysfunction showed clustered depression and anxiety, but not depression alone or anxiety alone, was an independent predictor of the primary outcome (HR 1.96, 95% CI: 1.00-3.27, p = 0.04). Conclusions: Our results showed that clustered depression and anxiety were associated with worse outcomes in patients with HF.
Depression and Anxiety in Heart Failure
Journal of Cardiac Failure, 2005
Although common among patients with heart failure, depression and anxiety have been relatively neglected by researchers and practitioners. Both depression and anxiety have been implicated in contributing independently to the poor outcomes seen in patients with heart failure. Emphasis in the literature is on physical symptom recognition and management, in contrast to the patient's perspective of the effects of heart failure on his or her daily life. Methods and Results: This review summarizes and integrates research findings on anxiety and depression and translates these findings to clinical practice. Depression and anxiety are prevalent among patients with heart failure and require assessment and intervention. Short-term nonpharmacologic approaches, in conjunction with drug therapy, hold promise for successful management of patients who are depressed or anxious. Conclusion: Carefully designed clinical trials that are tailored to individual needs, yet are embedded within a systemic framework, are needed to inform clinicians regarding optimal practices for the treatment of patients with heart failure who suffer from depression or anxiety.
Linkages between anxiety and outcomes in heart failure
Heart & Lung, 2011
OBJECTIVE-To investigate the relationship between anxiety and event-free survival (i.e., composite endpoint of death, emergency department visits, or hospitalizations) for patients with HF, and examine whether behavioral and physiologic mechanisms mediate any association between anxiety and outcomes. METHODS-In this longitudinal study, patients with HF completed the anxiety subscale of the Brief Symptom Inventory, and heart rate variability and plasma norepinephrine level were measured. Dietary and medication adherence were measured with a 24-hour urine sodium level and the Medication Event Monitoring System, respectively. Patients were followed at least 1 year for event-free survival. RESULTS-A total of 147 patients were enrolled. Patients with high anxiety had a shorter (HR 2.2, 95% CI 1.1-4.3, P = .03) period of event-free survival than patients with lower anxiety. Anxiety independently predicted medication adherence (P = .008), which in turn predicted eventfree survival (HR 2.0, CI 1.2-3.3, P = .008). The effect of anxiety (P = .17) on event-free survival was less significant when the regression model included both anxiety and medication adherence