Coexisting anxiety and depressive symptoms in patients with heart failure

Abstract

Background: Among patients with heart failure (HF), anxiety symptoms may co-exist with depressive symptoms. However, the extent of overlap and risk factors for anxiety symptoms have not been thoroughly described.

Purpose: The aim of this study was to describe the coexistence of anxiety and depressive symptoms, and to determine the predictors of anxiety symptoms in patients with HF.

Methods: The sample consisted of 556 outpatients with HF (34% female, 62±12 years, 54% New York Heart Association (NYHA) class III/IV) enrolled in a multicenter HF quality of life registry. Anxiety symptoms were assessed with the Brief Symptom Inventory-anxiety subscale. Depressive symptoms were measured with the Beck Depression Inventory-II (BDI). We used a cut-point of 0.35 to categorize patients as having anxiety symptoms or no anxiety symptoms. Logistic regression was used to determine whether age, gender, minority status, educational level, functional status, comorbidities, depressive symptoms, and antidepressant use were predictors of anxiety symptoms.

Results: One-third of patients had both depressive and anxiety symptoms. There was a dose-response relationship between depressive symptoms and anxiety symptoms; higher levels of depressive symptoms were associated with a higher level of anxiety symptoms. Younger age (odds ratio (OR)= 0.97, p=0.004, 95% confidence interval (CI) 0.95-0.99) and depressive symptoms (OR =1.25, p<0.001, 95% CI 1.19-1.31) were independent predictors of anxiety symptoms.

Conclusions: Patients with HF and depressive symptoms are at high risk for experiencing anxiety symptoms. Clinicians should assess these patients for comorbid anxiety symptoms. Research is needed to test interventions for both depressive and anxiety symptoms.

Keywords: Cardiovascular; anxiety disorder; depressive disorder; heart failure.

Figure 1

Relationship between the level of anxiety symptoms and the level of depressive symptoms *Data presented by number (n) †BSI = Brief Symptom Inventory anxiety subscale; BSI ≤ 0.35: anxiety symptoms lower than the mean of healthy adults, BSI 0.351–1.7: anxiety symptoms higher than the mean anxiety level of healthy adults but lower than the mean level of psychiatric patients; BSI > 1.7: anxiety symptoms higher than the mean level of psychiatric patients ‡BDI = Beck Depression Inventory; BDI 0–13: none to minimal depressive symptoms; BDI 14–19: mild symptoms; BDI 20–28: moderate symptoms: BDI 29–63: severe symptoms