title: Anxiety in chronic heart failure and the risk of increased hospitalisations and mortality: A systematic review.
abstract: Anxiety is a serious affective mood disorder that affects many chronic heart failure patients. While there is ample evidence that depression increases hospitalisations and mortality in chronic heart failure patients, it is unclear whether this association also exists for anxiety.
  
  
  
  The purpose of this study was to report on prospective cohort studies investigating anxiety in chronic heart failure patients and its association with hospitalisations and mortality rates. This systematic review aims to improve the current knowledge of anxiety as a potential prognostic predictor in chronic heart failure populations.
  
  
  
  This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were identified by accessing electronic databases Embase, Medline, Cumulative Index to Nursing and Allied Health Literature and PsycINFO. Studies were included if they: employed a prospective cohort study design, included chronic heart failure participants with a confirmed clinical diagnosis plus anxiety confirmed by a validated anxiety assessment tool and/or clinical diagnosis and reported longitudinal hospitalisation rates and mortality data in chronic heart failure.
  
  
  
  Six studies were identified for inclusion. A study investigating hospitalisations and mortality rates found a significant (p<0.05) association solely between hospitalisation and anxiety. Of four studies reporting on hospitalisations alone, only two reported significant associations with anxiety. One study reported rates of mortality alone and identified no significant associations between mortality and anxiety. There was some variation in quality of the studies in regards to their methodology, analysis and reported measures/outcomes, which may have affected the results reported.
  
  
  
  It is possible that anxiety does predict hospitalisations in chronic heart failure populations, however further research is required to confirm this observation.
authors.affiliation: Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Australia Jeffrey.Vongmany@uts.edu.au.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Vongmany
authors.affiliation: Faculty of Health, University of Technology Sydney, Australia.
authors.forename: Louise D
authors.initials: LD
authors.lastname: Hickman
authors.affiliation: Faculty of Health, University of Technology Sydney, Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Lewis
authors.affiliation: Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Australia.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Newton
authors.affiliation: Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Australia.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Phillips
mesh_terms: D001007:Anxiety; D002908:Chronic Disease; D006333:Heart Failure / Q000451:nursing*; D006760:Hospitalization; D006801:Humans; D011446:Prospective Studies
keywords: Anxiety; chronic heart failure; hospitalisations; mortality; prognosis