title: Prognostic value of one-year course of symptoms of anxiety and depression in patients with coronary heart disease: Role of physical activity and unmet medical need.
abstract: BACKGROUND
  Symptoms of depression and anxiety contribute to determining prognosis of patients with coronary heart disease. We evaluated the association of the one-year course of symptoms of anxiety and depressive symptoms with fatal and non-fatal cardiovascular disease-events during 10-year follow-up and assessed the utilization of anti-depressant and psycholeptic medication.
  
  
  METHODS
  Prospective cohort study in coronary heart disease patients aged 30-70 years with stable coronary heart disease. Symptoms of anxiety and depression were evaluated at baseline and follow-up using the Hospital Anxiety and Depression Scale. Associations with fatal and non-fatal cardiovascular disease events were determined by a Cox-proportional hazards model.
  
  
  RESULTS
  Nine hundred and ninety-six patients were included in this study. Of the 862 patients with a normal depression symptom score at baseline 10.3% had an increased score at one-year follow-up. Of those with an elevated symptom score at baseline, 62.7% still had an elevated score after one year. During follow-up (median 8.9 years) fatal and non-fatal cardiovascular disease events were observed in 152 patients. One year course of depressive symptoms was associated with cardiovascular disease events during follow-up (p-value for trend 0.029); for example, patients with an increase of depressive symptoms had a hazard ratio of 1.93 (95% confidence interval 1.08-3.34) compared with patients with a normal score at baseline as well as at one-year follow-up. However, if physical activity was considered as a covariate, the HRs attenuated and the association was no longer statistically significant. The utilization of anti-depressant medication in the overall population was low (overall 2%).
  
  
  CONCLUSIONS
  The study supports a role of the one year course of symptoms of depression for long-term prognosis of patients with known coronary heart disease, which might be partly mediated by lack of physical activity.
authors: Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany dietrich.rothenbacher@uni-ulm.de.
authors: Dietrich
authors: D
authors: Rothenbacher
authors: Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
authors: Andrea
authors: A
authors: Jaensch
authors: Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany.
authors: Ute
authors: U
authors: Mons
authors: Klinik Schwabenland, Isny-Neutrauchburg, Germany.
authors: Harry
authors: H
authors: Hahmann
authors: Department of Psychiatry II, Ulm University, Günzburg, Germany.
authors: Thomas
authors: T
authors: Becker
authors: Department of Internal Medicine II-Cardiology, University of Ulm Medical Centre, Ulm, Germany.
authors: Wolfgang
authors: W
authors: Koenig
authors: Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany.
authors: Hermann
authors: H
authors: Brenner
mesh_terms: D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology; D017723:Drug Utilization Review; D005260:Female; D005858:Germany; D006301:Health Services Needs and Demand; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D020380:Needs Assessment; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D057185:Sedentary Behavior; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents
keywords: Anxiety; cardiovascular disease events; cohort study; coronary heart disease; course; depression