title: The association of co-morbid symptoms of depression and anxiety with all-cause mortality and cardiac rehospitalization in patients with heart failure.
abstract: BACKGROUND
  Patients with heart failure (HF) experience multiple psychologic symptoms. Depression and anxiety are independently associated with survival. Whether co-morbid symptoms of anxiety and depression are associated with outcomes in patients with HF is unknown.
  
  
  OBJECTIVE
  To determine whether co-morbid symptoms of depression and anxiety are associated with all-cause mortality or rehospitalization for cardiac causes in patients with HF.
  
  
  METHODS
  A total of 1260 patients with HF participated in this study. Cox regression analysis was used to determine whether co-morbid symptoms of depression and anxiety independently predicted all-cause mortality and cardiac rehospitalization. Anxiety and depression were treated first as continuous-level variables, then as categorical variables using standard published cut points. Patients were then divided into 4 groups based on the presence of anxiety and depression symptoms.
  
  
  RESULTS
  When entered as a continuous variable, the interaction between anxiety and depression (hazard ratio = 1.02; 95% CI: 1.01-1.03; p = 0.002) was a significant predictor of all-cause mortality in patients with HF. When entered as a categorical variable, co-morbid symptoms of depression and anxiety (vs no symptoms or symptoms of anxiety or depression alone) independently predicted all-cause mortality (hazard ratio = 2.59; 95% CI: 1.49-4.49; p = 0.001). None of the psychologic variables was a predictor of cardiac rehospitalization in patients with HF whether using the continuous or categorical level of measurement.
  
  
  CONCLUSIONS
  To improve mortality outcomes in patients with HF, attention must be paid by health care providers to the assessment and management of co-morbid symptoms of depression and anxiety.
authors.affiliation: University of Kentucky, Lexington, KY; The University of Jordan, Amman, Jordan. Electronic address: asal223@uky.edu.
authors.forename: Abdullah S
authors.initials: AS
authors.lastname: Alhurani
authors.affiliation: University of Kentucky, Lexington, KY.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Dekker
authors.affiliation: The Hashemite University, Zarqa, Jordan.
authors.forename: Mona A
authors.initials: MA
authors.lastname: Abed
authors.affiliation: The University of Jordan, Amman, Jordan.
authors.forename: Amani
authors.initials: A
authors.lastname: Khalil
authors.affiliation: Arabic Community College, Amman, Jordan.
authors.forename: Marwa H
authors.initials: MH
authors.lastname: Al Zaghal
authors.affiliation: University of Kentucky, Lexington, KY.
authors.forename: Kyoung Suk
authors.initials: KS
authors.lastname: Lee
authors.affiliation: University of Kentucky, Lexington, KY.
authors.forename: Gia
authors.initials: G
authors.lastname: Mudd-Martin
authors.affiliation: University of Kentucky, Lexington, KY.
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Biddle
authors.affiliation: University of Kentucky, Lexington, KY.
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
authors.affiliation: University of Kentucky, Lexington, KY.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
mesh_terms: D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000523:psychology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors