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. 2013 Mar 19;2(2):e000068.
doi: 10.1161/JAHA.112.000068.

Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease

Lana L Watkins  1 , Gary G Koch, Andrew Sherwood, James A Blumenthal, Jonathan R T Davidson, Christopher O'Connor, Michael H Sketch
Affiliations

Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease

Lana L Watkins et al. J Am Heart Assoc. .

Abstract

Background: Depression has been related to mortality in coronary heart disease (CHD) patients, but few studies have evaluated the role of anxiety or the role of the co-occurrence of depression and anxiety. We examined whether anxiety is associated with increased risk of mortality after accounting for depression in individuals with established CHD.

Methods and results: The cohort was composed of 934 men and women with confirmed CHD (mean age, 62±11 years) who completed the Hospital Anxiety and Depression scale (HADS) during hospitalization for coronary angiography. Over the 3-year follow-up period, there were 133 deaths. Elevated scores on the HADS anxiety subscale (HADS-A≥8) were associated with increased risk of mortality after accounting for established risk factors including age, congestive heart failure, left ventricular ejection fraction, 3-vessel disease, and renal disease (hazard ratio [HR], 2.27; 95% CI, 1.55 to 3.33; P<0.001). Elevated scores on the HADS depression subscale (HADS-D≥8) were also associated with increased risk of mortality (HR, 2.18; 95% CI, 1.47 to 3.22; P<0.001). When both psychosocial factors were included in the model, each maintained an association with mortality (anxiety, HR, 1.83; 95% CI, 1.18 to 2.83; P=0.006; depression, HR, 1.66; 95% CI, 1.06 to 2.58; P=0.025). Estimation of the HR for patients with both anxiety and depression versus those with neither revealed a larger HR than for patients with either factor alone (HR, 3.10; 95% CI, 1.95 to 4.94; P<0.001).

Conclusions: Anxiety is associated with increased risk of mortality in CHD patients, particularly when comorbid with depression. Future studies should focus on the co-occurrence of these psychosocial factors as markers of increased mortality risk.

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Figures

Figure 1.
Figure 1.
Flow chart showing numbers of patients screened, excluded, and enrolled. CAD indicates coronary artery disease; MI, myocardial infarction; HADS, Hospital Anxiety and Depression Scale.
Figure 2.
Figure 2.
Hazard plot of the association between quartile of Hospital Anxiety and Depression Scale–Anxiety (HADS‐A) score and mortality.
Figure 3.
Figure 3.
Hazard plot of the association between quartile of Hospital Anxiety and Depression Scale–Depression (HADS‐D) score and mortality.
See this image and copyright information in PMC

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