Prognostic value of anxiety and depression in patients with chronic heart failure.
BACKGROUND
Anxiety is often present with depression and may be one of its manifestations. Although the adverse effects of depression in patients with chronic heart failure (CHF) have been well studied, the relation between anxiety and CHF prognosis has not been addressed. In a secondary analysis of data collected for a published study of depression and prognosis in patients with CHF, we examined the relations among anxiety, depression, and prognosis.


RESULTS
We measured symptoms of anxiety with the Spielberger State-Trait Anxiety Inventory (STAI) scale and symptoms of depression with the Beck Depression Inventory (BDI) scale in 291 patients with CHF hospitalized as a result of cardiac events. We followed up these patients for all-cause mortality over 1 year. The mean scores for state anxiety (State-A) and trait anxiety (Trait-A) were identical at 33.5; the mean BDI score was 8.7+/-7.6. State-A and Trait-A scores correlated highly with each other (r=0.85; P<0.01) and with BDI score (State-A, r=0.52; Trait-A, r=0.59; P<0.01). Cox proportional-hazards model with and without confounding variables showed no relation between State-A or Trait-A and 1-year mortality. BDI scores, however, significantly predicted increased mortality during 1-year follow-up (hazard ratio, 1.04 for each 1-unit increase; P<0.01).


CONCLUSIONS
Although anxiety and depression are highly correlated in CHF patients, depression alone predicts a significantly worse prognosis for these patients.
Jiang
Wei
W
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. jiang001@mc.duke.edu
Kuchibhatla
Maragatha
M
Cuffe
Michael S
MS
Christopher
Eric J
EJ
Alexander
Jude D
JD
Clary
Greg L
GL
Blazing
Michael A
MA
Gaulden
Laura H
LH
Califf
Robert M
RM
Krishnan
Ranga R
RR
O'Connor
Christopher M
CM
D000368:Aged; D001007:Anxiety / Q000150:complications* / Q000523:psychology; D002423:Cause of Death; D003863:Depression / Q000150:complications* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011581:Psychological Tests; D012720:Severity of Illness Index; D013318:Stroke Volume