Psychological predictors of prognosis in chronic heart failure.
BACKGROUND
Chronic heart failure (CHF) is an increasingly prevalent condition with high mortality and morbidity rates. This review examines the role of depression, anxiety, and social support on prognosis in CHF.


RESULTS
Prospective studies that examined mortality as an outcome, and assessed depression, anxiety, or social support as associates were included. Methodological qualities were evaluated. In total, 25 studies were identified. Concerning depression, 6 of 15 studies of inpatients, 10 of 11 studies of outpatients, and 1 study of a mixed sample found associations between depression and prognosis, with greater associations rendered by depressive symptomatology in outpatients. Anxiety was not associated with prognosis in one inpatient study and one outpatient study. There was a univariable trend in one outpatient study for anxiety to be associated with prognosis. In two of six studies of inpatients and in two of four studies of outpatients, social support was associated with prognosis. On the basis of methodological quality, studies on depression showed mixed results, no conclusions could be drawn for anxiety because this association was not investigated soundly, and the quality of the social network was not associated with outcome.


CONCLUSIONS
Evidence suggests that depressive symptoms and social support might be associated with prognosis in CHF outpatients, independently of biomedical risk factors. With respect to anxiety, no conclusions can be drawn. Future studies are warranted to disentangle associations with psychological factors.
Pelle
Aline J M
AJ
CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, The Netherlands.
Gidron
Yori Y
YY
Szabó
Balázs M
BM
Denollet
Johan
J
D001007:Anxiety / Q000150:complications; D002908:Chronic Disease; D003863:Depression / Q000150:complications* / Q000209:etiology; D018450:Disease Progression; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality / Q000523:psychology*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D010045:Outpatients / Q000706:statistics & numerical data; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D012944:Social Support; D016896:Treatment Outcome