title: Impact of clustered depression and anxiety on mortality and rehospitalization in patients with heart failure.
abstract: 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.
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: mshiga@hij.twmu.ac.jp.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shiga
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan; Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Kazue
authors.initials: K
authors.lastname: Kuwahara
authors.affiliation: Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Sayaka
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Faculty of Human Sciences, Waseda University, Tokorozawa, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Katsuji
authors.initials: K
authors.lastname: Nishimura
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Suzuki
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Minami
authors.affiliation: Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Ishigooka
authors.affiliation: Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kasanuki
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Hagiwara
mesh_terms: D001008:Anxiety Disorders / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology*; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000523:psychology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Anxiety; Cluster; Depression; Heart failure; Outcome