title: Psychological distress and mortality in patients with acute dyspnea: data from the Akershus Cardiac Examination (ACE) 2 Study.
abstract: OBJECTIVE
  To test the hypotheses that anxiety and depression are associated with etiology, disease severity and mortality in patients hospitalized with acute dyspnea.
  
  
  METHODS
  The Hospital Anxiety and Depression Scale was completed within 48h of admission in 185 patients. A subscale score of ≥8 was regarded as clinically significant. The etiology and severity of dyspnea on admission and all-cause mortality during follow-up (median, 2.3years) were recorded.
  
  
  RESULTS
  Anxiety and depression were more prevalent in patients with chronic obstructive pulmonary disease (COPD) (n=53; 42% and 31%) and heart failure (HF) (n=80; 33% and 23%) than in other causes of acute dyspnea (15% and 11%). Psychological distress was not associated with clinical status or cardiac biomarkers. Anxiety, but not depression, was associated with increased mortality, also when adjusting for cardiac biomarkers in multivariate Cox analysis. In contrast, anxiety was not associated with mortality after adjustment for body mass index, history of COPD and disease severity (hazard ratio, 1.67; 95% confidence interval, 0.92-3.00).
  
  
  CONCLUSIONS
  Psychological distress was associated with COPD and HF as etiology of acute dyspnea, but not with disease severity. Anxious patients had a higher mortality rate, but this association was related to the presence and severity of COPD.
authors: Division of Medicine, Akershus University Hospital, 1470 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, 0450 Oslo, Norway. Electronic address: Gunnar.einvik@medisin.uio.no.
authors: Gunnar
authors: G
authors: Einvik
authors: Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, 0372 Oslo, Norway. Electronic address: Toril.dammen@medisin.uio.no.
authors: Toril
authors: T
authors: Dammen
authors: Division of Medicine, Akershus University Hospital, 1470 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, 0450 Oslo, Norway. Electronic address: a.d.hoiseth@ahus.no.
authors: Arne Didrik
authors: AD
authors: Høiseth
authors: Division of Medicine, Akershus University Hospital, 1470 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, 0450 Oslo, Norway. Electronic address: jon.brynildsen@ahus.no.
authors: Jon
authors: J
authors: Brynildsen
authors: Institute of Clinical Medicine, University of Oslo, 0450 Oslo, Norway; Division of Diagnostics and Technology, Akershus University Hospital, 1470 Lørenskog, Norway. Electronic address: Tor-arne.hagve@medisin.uio.no.
authors: Tor-Arne
authors: TA
authors: Hagve
authors: Institute for Experimental Medical Research, University of Oslo and Oslo University Hospital, 0450 Oslo, Norway. Electronic address: Geir.christensen@medisin.uio.no.
authors: Geir
authors: G
authors: Christensen
authors: Division of Medicine, Akershus University Hospital, 1470 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, 0450 Oslo, Norway. Electronic address: torbjorn.omland@medisin.uio.no.
authors: Torbjørn
authors: T
authors: Omland
authors: Division of Medicine, Akershus University Hospital, 1470 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, 0450 Oslo, Norway. Electronic address: helge.rosjo@medisin.uio.no.
authors: Helge
authors: H
authors: Røsjø
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D004417:Dyspnea / Q000209:etiology / Q000401:mortality* / Q000523:psychology*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D015995:Prevalence; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications*
keywords: Anxiety; Chronic obstructive pulmonary disease; Depression; Heart failure; Mortality