title: Symptoms of depression and anxiety predict mortality in patients undergoing oral anticoagulation: Results from the thrombEVAL study program.
abstract: OBJECTIVE
  Depression and anxiety are highly prevalent in cardiovascular patients. Therefore, we examined whether the 4-item Patient Health Questionnaire (PHQ-4, measuring symptoms of depression and anxiety) predicts all-cause mortality in outpatients with long-term oral anticoagulation (OAC).
  
  
  METHODS
  The sample comprised n=1384 outpatients from a regular medical care setting receiving long-term OAC with vitamin K antagonists. At baseline, symptoms of anxiety and depression were assessed with the PHQ-4 and the past medical history was taken. The outcome was all-cause mortality in the 24 month observation period. The median follow-up time was 13.3 months.
  
  
  RESULTS
  N=191 patients from n=1384 died (death rate 13.8%). Each point increase in the PHQ-4 score was associated with a 10% increase in mortality (hazard ratio [HR] 1.10, 95% confidence interval [95% CI] 1.05-1.16) after adjustment for age, sex, high school graduation, partnership, smoking, obesity, frailty according to the Barthel Index, Charlson Comorbidity Index and CHA2DS2-VASc score. The depression component (PHQ-2) increased mortality by 22% and anxiety (GAD-2) by 11% respectively. Neither medical history of any mental disorder, nor intake of antidepressants, anxiolytics or hypnotics predicted excess mortality.
  
  
  CONCLUSIONS
  Elevated symptoms of depression and, to a lesser degree, symptoms of anxiety are independently associated with all-cause mortality in OAC outpatients. The PHQ-4 questionnaire provides valuable prognostic information. These findings emphasize the need for implementing regular screening procedures and the development and evaluation of appropriate psychosocial treatment approaches for OAC patients.
authors: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany. Electronic address: michal@uni-mainz.de.
authors: Matthias
authors: M
authors: Michal
authors: Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors: Jürgen H
authors: JH
authors: Prochaska
authors: Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors: Karsten
authors: K
authors: Keller
authors: Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany.
authors: Sebastian
authors: S
authors: Göbel
authors: Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors: Meike
authors: M
authors: Coldewey
authors: Preventive Cardiology and Preventive Medicine, Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors: Alexander
authors: A
authors: Ullmann
authors: Preventive Cardiology and Preventive Medicine, Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors: Andreas
authors: A
authors: Schulz
authors: Preventive Cardiology and Preventive Medicine, Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors: Heidrun
authors: H
authors: Lamparter
authors: Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany.
authors: Thomas
authors: T
authors: Münzel
authors: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors: Iris
authors: I
authors: Reiner
authors: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors: Manfred E
authors: ME
authors: Beutel
authors: Preventive Cardiology and Preventive Medicine, Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany.
authors: Philipp S
authors: PS
authors: Wild
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000401:mortality*; D003866:Depressive Disorder / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011446:Prospective Studies; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: Anxiety; Depression; Mortality; Oral anticoagulation; Patient Health Questionnaire (PHQ); Screening