Psychological profile of COVID-19 pneumonia survivors three month after hospitalization

Abstract Background COVID-19 is the highly contagious infectious disease, which affects different organs and systems. Anxiety and depression symptoms, that are common results of severe diseases, used to make recovery more difficult. Purpose To study the prevalence of cardiovascular diseases, signs of anxiety, depression, stress, and their relationship in patients with proven COVID-19 pneumonia 3 months after discharge depending of gender. Methods The study was carried out within “One-year Cardiac Follow-up of COVID-19 Pneumonia”. 103 patients (mean age 46.6±15.8 years) were divided into 2 groups: 52 men (50.9%) and 51 women. Anxiety and depression symptoms were measured by GAD-7 and PHQ-9, respectively. PSS-10 was used to measure stress symptoms. The minimum value of anxiety and depression was a total value of 5 points. Results 48.5% of patients had cardiovascular diseases, out of which arterial hypertension (AH) was the most common (44.7%). Less common was coronary artery disease (CAD) (16.5%), which in 14.6% of patients was accompanied by AH. Chronic heart failure (CHF) NYHA class I-II was found in 19.4% of patients, and severe CHF (NYHA class III–IV) - in 4.9%. Arrhythmia was detected in 11.7% of patients. According to the clinical characteristics, no significant differences were found between the groups of men and women. AH affected 21.4% of men and 23.3% of women, CAD −10.7% and 5.8%, respectively. NYHA class I-II CHF were found in 8.7% of men and 10.7% of women, and severe CHF (NYHA class III–IV) - in 2 men and 3 women. Arrhythmia had a prevalence of less than 6% among both men and women. Anxiety or depression symptoms were reported in 29.1% and 27.2%, respectively. Combination of anxiety and depression symptoms was determined in 18.4%, symptoms of stress in 8.7% of patients. Symptoms of depression were found in women more often (p=0.023). The value of the median scores of the PHQ-9 questionnaire in the group of women was significantly higher than in the group of men (3.00 [1.00; 8.00] and 1.00 [0; 3.75], p=0.006). Depression symptoms were associated with female gender (OR 2.83; CI 95% 1.35–7.08). Despite the absence of gender differences in the prevalence of anxiety (18.4% and 10.7%, p=0.072), when comparing the values of the median scores of the GAD-7 questionnaire in the groups of men and women, the difference was statistically significant (1.00 [0; 4.00] and 3.00 [2.00; 7.00], p=0.001, respectively). Signs of stress among married people were less common in comparison with unmarried (2.9% vs 5.8%, p=0.037). Conclusion Three months after discharge, no significant differences in clinical characteristics between men and women were found. Signs of anxiety or depression were detected in more than a quarter of patients with proven COVID-19-associated pneumonia. Women experienced symptoms of depression 3 times more often than men. Unmarried patients tended to experience stress more often. FUNDunding Acknowledgement Type of funding sources: None.

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Abstract 17105: Is There a Difference in Lean and Fat Mass in HF Patients Based on NYHA Classifications (I-II versus III-IV)?

Circulation ◽

10.1161/circ.138.suppl_1.17105 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Christine Haedtke ◽

Debra K Moser ◽

Susan J Pressler ◽

Terry Lennie

Keyword(s):

Body Composition ◽

Fat Mass ◽

Lean Mass ◽

Nyha Class ◽

Class I ◽

Unexpected Finding ◽

Class Iii ◽

Medication Regimen ◽

Cross Sectional ◽

Nyha Classification

Introduction: As NYHA Class increases from I (ordinary physical activity does not cause undue fatigue), to Class IV (Symptoms are present while at rest) physical limitations become severe. It has previously been shown that HF patients have increased fat within the muscle thus decreasing exercise performance and tolerance. It is unclear if all NYHA classes are similarly affected. Hypothesis: HF patients with NYHA class III-IV will have more fat and less lean mass than those with NYHA class I-II. Methods: Secondary data analysis using cross sectional data from N=253. The parent study was a multicenter study about nutrition and body composition among patients with HF (preserved or reduced, and NYHA classification I-IV) who had been on a stable medication regimen, able to participate in dual-energy X-ray absorptiometry scan and/or BodPod body composition measures, able to read and speak English, and had no cognitive impairment. Women and men were analyzed separately due to known differences in fat and lean mass. Results: Table 1: Sample characteristic’s Testing the hypothesis using 2-way ANOVA and comparing the percentage of body weight that is lean and fat mass in NYHA class I-II vs III-IV found the interaction of gender and NYHA was not significant in either % lean or %fat (p=0.221, 0.190 respectively). NYHA class by itself was not significant (p=0.067) in %lean but was significant in %fat (p=0.046). Gender was significant in both %lean and %fat with men having 9.6% less fat (1.139 SE) and 9.8% more lean mass (1.066 SE) (p≤0.001). NYHA class III-IV had 2.3% (1.139 SE) more fat than those in NYHA class I-II. The R squared was 0.265 and adjusted R squared was 0.256. Conclusions: Part of our hypothesis was correct in that NYHA class III-IV had more fat mass than those in class I-II, but no difference was found in lean. This is an unexpected finding as healthy people gain fat mass while losing lean mass as they age. Additional studies are needed to further examine this result.

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Abstract 14647: Stress Echocardiography Predicts Heart Failure Progression and Alters Management Strategies in Patients with Hypertrophic Cardiomyopathy

Circulation ◽

10.1161/circ.130.suppl_2.14647 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Ethan J Rowin ◽

Barry J Maron ◽

Iacopo Olivotto ◽

Susan A Casey ◽

Anna Arretini ◽

...

Keyword(s):

Heart Failure ◽

Nyha Class ◽

Management Strategies ◽

Left Ventricular ◽

Advanced Heart Failure ◽

Outflow Tract ◽

Class I ◽

Class Iii ◽

Outflow Obstruction ◽

Heart Failure Progression

Background: One-third of HCM patients without left ventricular outflow tract obstruction under resting conditions have the propensity to develop an outflow gradient with physiologic exercise. However, the natural history and management implications of exercise-induced (i.e., provocable) obstruction is unresolved. Methods: We prospectively studied 533 consecutive HCM patients without outflow obstruction at rest (<30mmHg) who underwent a symptom limiting stress (exercise) echocardiogram to assess development of outflow obstruction following physiologic provocation and followed for 6.5 ± 2.0 years. Of the 533 patients, obstruction ≥ 30 mmHg was present following exercise in 262 patients (49%; provocable obstruction), and was absent both at rest and with exercise in 271 (51%; nonobstructive). Results: Over the follow-up period, 43 out of 220 (20%) HCM patients with provocable obstruction and baseline NYHA class I/II symptoms developed progressive limiting heart failure symptoms to class III/IV, compared to 24 of 249 (10%) nonobstructive patients. Rate of heart failure progression was significantly greater in patients with provocable obstruction vs. nonobstructive patients (3.1%/year vs. 1.5%/year; RR=2.0, 95% CI of 1.3-3.2; p=0.003). However, the vast majority of patients with provocable obstruction who developed advanced heart failure symptoms achieved substantial improvement in symptoms to class I / II following relief of obstruction with invasive septal reduction therapy (n=30/32; 94%). In comparison, the majority of nonobstructive patients who developed advanced heart failure remained in class III/IV (16/24;67%), including 10 (42%) currently listed for heart transplant. Conclusions: Stress (exercise) echocardiogram identifies physiological provocable outflow tract obstruction in HCM, and is a predictor of future risk for progressive heart failure (3.1%/year), in patients who become candidates for invasive septal reduction therapy. Therefore, exercise echocardiography should be considered in all HCM patients without obstruction under resting conditions.

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Anxiety and depression symptoms in older adults during coronavirus disease 2019 pandemic: A community-based cross-sectional study

SAGE Open Medicine ◽

10.1177/20503121211040050 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110400

Author(s):

Kemal Jemal ◽

Tinsae Abeya Geleta ◽

Berhanu Senbeta Deriba ◽

Mukemil Awol

Keyword(s):

Older Adults ◽

Chronic Disease ◽

Cross Sectional Study ◽

Anxiety And Depression ◽

Depression Symptoms ◽

High Morbidity ◽

Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Symptoms Of Depression

Objectives: The coronavirus disease 2019 pandemic has caused high morbidity and mortality in older adults over the world. Because the coronavirus disease 2019 pandemic greatly affects older adults who have a preexisting health condition, they are generally susceptible to a high incidence of severe symptoms of anxiety and depression. Therefore, we aimed to assess the prevalence of anxiety and depression symptoms in older adults during the coronavirus disease 2019 pandemic. Methods: Community-based cross-sectional study was completed in August 2020. Standardized and pretested General Anxiety Disorder–7 and Geriatric Depression Scale were used to screen the symptoms of anxiety and depression, respectively. Data were entered into EpiData (version 4.3.2) and transferred to SPSS (version 24) for further analysis. Bivariate and multivariate logistic regression analyses were carried out to determine the significantly associated variables with a 95% confidence interval at p < 0.05. Results: Of the total older adults interviewed, 68.7% had developed symptoms of anxiety and 59.9% had symptoms of depression during the coronavirus disease 2019 pandemic. Female participants, having a chronic disease and poor knowledge of the coronavirus disease 2019 pandemic, were significantly associated with anxiety symptoms. Age category of 81 to 90 and above 90, lack of social support, and having a chronic disease were significantly associated with symptoms of depression. Conclusion: The symptoms of anxiety and depression among older adults in the North Shoa Zone during coronavirus disease 2019 were higher than before the coronavirus disease 2019 happened. The results were evidence points for developing a psychological intervention to tackle the older adults’ mental health needs in the community during and after the coronavirus disease 2019 pandemic.

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Depressive Psoriasis-Patienten können ein schlechteres Ansprechen auf Etanercept zeigen

Karger Kompass Dermatologie ◽

10.1159/000496272 ◽

2019 ◽

Vol 7 (2) ◽

pp. 75-76

Author(s):

Wiebke Sondermann

Keyword(s):

Clinical Response ◽

Response Rate ◽

Depression Scale ◽

Female Gender ◽

Anxiety Symptoms ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Etanercept Treatment ◽

Depressed Patients ◽

Pasi Score

Background/Aims: This study aimed to investigate the predicting values of depression and anxiety symptoms for clinical response to etanercept treatment in psoriasis patients. Methods: A total of 85 psoriasis patients who received 6 months of etanercept treatment were consecutively enrolled in this prospective cohort study. The Psoriasis Area and Severity Index (PASI) score was evaluated at month 0 (M0), M1, M3, and M6, and the corresponding PASI 75/90 response at each visit was assessed. Also, anxiety and depression symptoms were assessed by the Hospital Anxiety and Depression Scale (HADS) at M0, M1, M3, and M6. Results: Depression symptoms were observed to correlate with female gender (p = 0.004), longer disease duration (p = 0.018), and higher PASI score (p < 0.001), and anxiety symptoms were seen to be associated with female gender (p = 0.017), larger psoriasis-affected body surface area (p = 0.049), and higher PASI score (p = 0.017) in psoriasis patients. After etanercept treatment, HADS-Depression (HADS-D) and HADS-Anxiety (HADS-A) scores were both decreased at M1, M3, and M6 (all p < 0.001) compared with M0. Most importantly, baseline depressed patients presented with a lower PASI 75 response rate at M3 (p = 0.014) and M6 (p = 0.005), and a reduced PASI 90 response rate at M6 (p = 0.045) compared with baseline non-depressed patients. Furthermore, multivariate logistic regression analyses revealed that depression symptoms at baseline were an independent predictive factor for the lower possibility of both PASI 75 response (p = 0.048) and PASI 90 response (p = 0.048) achievements at M6 in psoriasis patients. However, no correlation of baseline anxiety symptoms with PASI 75/90 responses was observed. Conclusion: Depression symptoms at baseline independently predict a worse clinical response to etanercept treatment in psoriasis patients.

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Outcome of Albumin Infusion in Heart Failure Patients

University Heart Journal ◽

10.3329/uhj.v15i2.42646 ◽

2019 ◽

Vol 15 (2) ◽

pp. 47-53

Author(s):

Ashaduzzaman Talukder ◽

Mohamed Mausool Siraj ◽

Md Noornabi Khondokar ◽

SM Ahsan Habib ◽

Md Abu Salim ◽

...

Keyword(s):

Heart Failure ◽

Serum Albumin ◽

Nyha Class ◽

Class Ii ◽

Class I ◽

Class Iii ◽

Albumin Infusion ◽

Group A ◽

Group B ◽

Class Iv

Background: Heart Failure (HF) is a major public health burden worldwide. Approximately 5 million Americans, 0.4–2% of the general European population and over 23 million people worldwide are living with heart failure. Like few other chronic disease, low serum albumin is common in patients with heart failure (HF). However, very few studies evaluated the outcome of albumin infusion in different stages of HF. Therefore, the objective of this study is to assess the outcome of albumin infusion in heart failure patients. Methods: It was a cross-sectional study. A total of 50 cases of chronic heart failure with reduced ejection fraction and NYHA class III or IV with serum albumin level <2.5g/dl who were admitted in CCUwere selected by purposive sampling, from September 2017 to August 2018. 100ml of 20% albumin was infused and serum albumin was measured after 3 days. Then the patients were divided into two groups, Patients who failed to attain serum albumin of 3g/dl(Group A) or Patients who attained serum albumin of ≥3g/dl (Group B). Analysis and comparison for symptomatic improvement of heart failure by NHYA classification and LVEF was done at 10th day after infusion between group A and B. Result: Among the 50 patients, mean age of patients was 53.64 ± 13.44 years (age range: 26-84 years) with a male-female ratio of 3:2 (60%-male vs 40%- female). Majority patients were previously re-admitted at least two times (40%), 28% were re-admitted once, 16% were re-admitted three times and 4% were re-admitted for four times. Of all, 56% patients presented NYHA class IV and AHA stage D heart failure (56%) and 44% patients presented with NYHA class III and AHA stage C. At day 10 follow up following albumin infusion, overall frequency of following ten days of albumin therapy, in group B, 8 patients (72.7%) among Class III improved to Class I and 3 patients (27.3%) improved to class II. Also, 7 patients (50%), 5 patients (35.7%) and 2 patients (14.3%) among class IV improved to respectively class I, class II and class III. In group A, 3 patients (27.3%) among class III improve to class II and 8 patients (72.7%) remain in class III. Also, 2 patients (14.3%), 5 Patients (35.7%) and 7 patients (50%) among class IV improve to respectively class I, class II and class III. Moreover, statistically significant improvement was noted in ejection fraction of patents irrespective of initial class of heart failure (p<0.001) in group B patients compare to group A (p<0.09). Conclusion: In this study, the improvement of heart failure was more in patients who attained albumin level of ≥3g/dl.Therefore, in can be concluded that albumin infusion improves both subjective and objective improvement of patients with heart failure. University Heart Journal Vol. 15, No. 2, Jul 2019; 47-53

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P320Heart failure with mid-range (HFmrEF) or recovered (HFrecEF) ejection fraction: differential determinants of transition

European Heart Journal ◽

10.1093/eurheartj/ehz747.0155 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Cited By ~ 1

Author(s):

R De Maria ◽

F Macera ◽

M Gorini ◽

I Battistoni ◽

M Iacoviello ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ejection Fraction ◽

Clinical Characteristics ◽

Nyha Class ◽

Multivariable Logistic Regression Analysis ◽

Class Iii ◽

Mild Disease ◽

Lower Likelihood ◽

History Of

Abstract Background Heart failure with mid-range ejection fraction (HFmrEF) has been identified as a multi-faceted phenotype that may encompass both patients with mild disease or those who from previous HFrEF recover EF (HFrecEF) Purpose To describe clinical characteristics and factors associated with phenotype transition at follow-up. Methods From 2009 to 2016, 1194 patients with baseline EF<50% and a second echocardiographic determination during clinically stability at a median of 6 months were enrolled in the IN-CHF Registry. Based on EF at enrollment, 335 (28%) had HFmrEF and 859 (72%) had HFrEF. We compared baseline clinical characteristics and predictors associated with follow-up reclassification to HFmrEF or full EF recovery Results When compared to HFrEF patients, those with HFmrEF had less often an ischemic etiology, advanced symptoms and a HF admission in the previous year. No other differences were found in clinical characteristics and drug therapy (Table). At a median follow-up of 6 months, 30% of HFrEF patients improved EF by 14 (9) units: 21% showed partial EF recovery (transition to HFmrEF) and 9% had full EF recovery. Conversely among HFmrEF patients 22% improved EF, by 9 (5) units, to full recovery, and 18% deteriorated by 1.5 (5.5) units sloping to HFrEF. By multivariable logistic regression analysis, variables associated with EF recovery at 6-month follow-up differed between baseline phenotypes. Within HFrEF, ischemic etiology (OR 0.46, 95% CI 0.33–0.64) and NYHA class III-IV symptoms (OR 0.57, 95% CI 0.38–0.68) were associated with a lower likelihood of EF recovery, while a history of HF<6 month correlated with a higher likelihood of EF recovery (OR 2.44, 95% CI 1.76–3.39). Within HFmrEF, while ischemic etiology (OR 0.66, 95% CI 0.19–0.68) was also associated with a lower likelihood of EF recovery, a history of atrial fibrillation at enrollment correlated with higher likelihood of EF recovery (OR 2.66, 95% CI 1.37–5.17) by 6 month-follow-up. At a median follow-up of 36+28 months mortality was 4.6% vs 6.9% in HFrecEF vs non-recovered patients (log rank p=0.08). Baseline characteristics HFrEF vs HFmrEF Conclusions HFmrEF patients showed a less severe clinical picture than HFrEF patients, but had EF recovery less often. EF improvement is negatively associated with ischemic etiology in both phenotypes, and positively associated with atrial fibrillation in HFmrEF and a short history of HF in HFrEF.

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Proportions of anxiety and depression symptoms in adult cleft patients and non-cleft patients with skeletal malocclusions

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.616 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s497-s497

Author(s):

V. Medvedev ◽

Y. Fofanova ◽

V. Frolova ◽

A. Drobyshev

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Anxiety Symptoms ◽

Open Bite ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Class Iii ◽

Anterior Open Bite ◽

Skeletal Class Ii ◽

Reactive Anxiety

IntroductionDiagnosis and treatment of patients with craniofacial anomalies such as cleft lip and palate and skeletal malocclusions present a challenge to public health. Dentofacial abnormalities may be associated with depressive and anxiety disorders and poor quality of life.The aim of this screening study was to evaluate and to compare the rates of anxiety and depression in cleft patients and non-cleft patients with skeletal malocclusions.MethodsThe study used psychometric method-HADS and State Trait Anxiety Inventory were used. The first group consisted of cleft patients, the second group consisted of non-cleft patients with skeletal Class II, Class III and anterior open bite malocclusions; the third group was control.ResultsStudy sample consists of 42 patients (33 females; 24 ± 7.2 years). In the 1st group, anxiety symptoms were detected in 34.7%; depression symptoms - in 17.2% of patients, high rates of reactive anxiety were registered in 35.8%. In the 2nd group, anxiety symptoms were detected in 29.6% of patients; depression symptoms - in 13,1% of patients, high rates of reactive anxiety were registered in 34.2%. In the 3rd group anxiety (18.7%) and depression (8.3%) symptoms and high rates of reactive anxiety (17.7%) were registered significantly less often than in 1st and 2nd groups (P < 0.005, P < 0.001 and P < 0.001 respectively).ConclusionsOur data suggest that cleft-patients and non-cleft patients with skeletal malocclusions have statistically significant higher rates of anxiety and depression than controls and require orthodontic-surgical treatment that should be organized with the assistance of psychiatrist.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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One-Year Survival and Renal Function Recovery of Acute Kidney Injury Patients with Chronic Heart Failure

Cardiorenal Medicine ◽

10.1159/000369834 ◽

2014 ◽

Vol 5 (1) ◽

pp. 40-47 ◽

Cited By ~ 4

Author(s):

Wen Zhang ◽

Dan Wen ◽

Yan-Fang Zou ◽

Ping-Yan Shen ◽

Yao-Wen Xu ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Acute Kidney Injury ◽

Chronic Heart Failure ◽

Clinical Characteristics ◽

Nyha Class ◽

Kidney Injury ◽

Class Iii ◽

Kidney Dysfunction ◽

Nyha Classification

Objective: To describe and analyze the clinical characteristics of acute kidney injury (AKI) patients with preexisting chronic heart failure (CHF) and to identify the prognostic factors of the 1-year outcome. Methods: A total of 120 patients with preexisting CHF who developed AKI between January 2005 and December 2010 were enrolled. CHF was diagnosed according to the European Society of Cardiology guidelines, and AKI was diagnosed using the RIFLE criteria. Clinical characteristics were recorded, and nonrecovery from kidney dysfunction as well as mortality were analyzed. Results: The median age of the patients was 70 years, and 58.33% were male. 60% of the patients had an advanced AKI stage (‘failure') and 90% were classified as NYHA class III/IV. The 1-year mortality rate was 35%. 25.83% of the patients progressed to end-stage renal disease after 1 year. Hypertension, anemia, coronary atherosclerotic heart disease and chronic kidney disease were common comorbidities. Multiple organ dysfunction syndrome (MODS; OR, 35.950; 95% CI, 4.972-259.952), arrhythmia (OR, 13.461; 95% CI, 2.379-76.161), anemia (OR, 6.176; 95% CI, 1.172-32.544) and RIFLE category (OR, 5.353; 95% CI, 1.436-19.952) were identified as risk factors of 1-year mortality. For 1-year nonrecovery from kidney dysfunction, MODS (OR, 8.884; 95% CI, 2.535-31.135) and acute heart failure (OR, 3.281; 95% CI, 1.026-10.491) were independent risk factors. Conclusion: AKI patients with preexisting CHF were mainly elderly patients who had an advanced AKI stage and NYHA classification. Their 1-year mortality and nonrecovery from kidney dysfunction rates were high. Identifying risk factors may help to improve their outcome.

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Examining the Role of Anxiety and Depression in Dietary Choices among College Students

Nutrients ◽

10.3390/nu12072061 ◽

2020 ◽

Vol 12 (7) ◽

pp. 2061

Author(s):

Michelle M. Keck ◽

Helize Vivier ◽

Jeffrey E. Cassisi ◽

Robert D. Dvorak ◽

Michael E. Dunn ◽

...

Keyword(s):

College Students ◽

Sex Differences ◽

Emerging Adults ◽

Fruits And Vegetables ◽

Caloric Intake ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Symptoms Of Depression ◽

Dietary Choices

This study examines the role of anxiety and depression symptoms in predicting dietary choices in emerging adults while accounting for sex differences in these relationships. Participants were 225 English speaking undergraduates enrolled in a university in southeastern United States. Participants were recruited through an online research recruitment application utilized by the university. Participants volunteered for a two-phased anonymous survey monitoring the effects of eating habits and gastrointestinal health in young adults. As part of this effort, participants completed self-reporting measures related to anxiety and depression, as well as an automated, self-administered 24-h diet recall. Multigroup path analysis was used to test primary hypotheses. Overall, a decrease in total caloric intake and an increase in sugar consumption were found as self-reported symptoms of anxiety and depression increased. In addition, there were sex differences in the relationship between depression and food choices. Men consumed more saturated fat as well as less fruits and vegetables as self-reported symptoms of depression increased. Results suggest symptoms of depression are a greater risk factor for poor nutrition in male college students than females. The findings provide another justification to screen for psychological distress in student health services given the implications on behavioral lifestyle and health.

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Abstract 11405: The Association of Co-Morbid Symptoms of Depression and Anxiety With All-Cause Mortality in Patients With Heart Failure

Circulation ◽

10.1161/circ.130.suppl_2.11405 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Abdullah Alhurani ◽

Rebecca Dekker ◽

Mona Abed ◽

Amani Khalil ◽

Kyoung Suk Lee ◽

...

Keyword(s):

Heart Failure ◽

Cox Regression ◽

Brief Symptom Inventory ◽

Categorical Variables ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Cox Regression Analysis ◽

Symptoms Of Depression ◽

All Cause Mortality

Introduction: Depression or anxiety are associated with survival in heart failure (HF); however, whether co-morbid symptoms of anxiety and depression are associated with survival in patients with HF is unknown. Hypothesis: Co-morbid symptoms of depression and anxiety are more strongly associated with all-cause mortality in patients with HF compared to those with anxiety or depression alone. Methods: A total of 1,260 HF patients participated and were followed for mortality outcomes for 12 months. The Patient Health Questionnaire (PHQ-9) and Brief Symptom Inventory-anxiety subscale (BSI) were used to measure symptoms of depression and anxiety. Cox regression analysis was used to determine whether co-morbid symptoms of depression and anxiety independently predicted all-cause mortality controlling for age,gender, ethnicity, and NYHA class. Depression and anxiety were treated first as continuous level variables, then as categorical variables using standard published cut points. Patients were divided into four groups based on the presence of anxiety and depression symptoms: 1) neither anxiety nor depression, 2) depression alone, 3) anxiety alone, and 4) co-morbid depression and anxiety Results: When entered as continuous variables, the interaction between anxiety and depression (HR 1.02; 95% CI: 1.01-1.03; p = 0.002) was a significant predictor of all-cause mortality. When entered as a categorical variable, co-morbid symptoms of depression and anxiety (versus the other three groups) independently predicted all-cause mortality (HR 2.59; 95% CI: 1.49-4.49; p = 0.001). Conclusions: To improve mortality outcomes in patient with HF, attention must be paid by healthcare providers to the assessment and management of co-morbid symptoms of depression and anxiety.

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