Synergistic Effect of Disease Severity, Anxiety Symptoms and Elderly Age on the Quality of Life of Outpatients with Heart Failure

Abstract

Background: Heart failure (HF) is a multifactorial syndrome with repercussions on quality of life (QoL).Objectives: To investigate the main interacting factors responsible to worsen quality of life of outpatients with HF.Methods: Cross-sectional observational study with 99 patients of both genders, attending a HF outpatient clinic at a university hospital, all with a reduced ejection fraction (<40%) by echocardiography. They were evaluated using sociodemographic and clinical questionnaires, the Minnesota Living with Heart Failure (MLwHF), and the Hospital Anxiety and Depression scale (HADS). QoL was the outcome variable. Two multivariate models were used: the parametric beta regression analysis, and the non-parametric regression tree, considering p < 0.05 and 0.05 < p < 0.10 for statistical and clinical significance, respectively.Results: Beta regression showed that depression and anxiety symptoms worsened the QoL of HF patients, as well as male sex, age younger than 60 years old, lower education level, lower monthly family income, recurrent hospitalizations and comorbidities such as ischemic heart diseases and arterial hypertension. The regression tree confirmed that NYHA functional class III and IV worsen all dimensions of MLwHF by interacting with anxiety symptoms, which influenced directly or indirectly the presence of poorer total score and emotional dimension of MLwHF. Previous hospitalization in the emotional dimension and age younger than 60 years in general dimension were associated with anxiety and NYHA functional class, also worsening the QoL of HF patients. Conclusion: HF with reduced ejection fraction was associated with poorer MLwHF. Anxiety symptoms, previous hospitalization and younger age were also associated with worsened MLwHF. Knowledge of these risk factors can therefore guide assessment and treatment of HF patients.

Anxiety and Depressive Disorders in Patients With Arterial Hypertension

“…Dippers had not different levels of health-related quality of life (HRQOL) as compared with non-dippers. LV hypertrophy was associated with lower scores on bodily pain and kidney failure was associated with lower scores on general health perception [7].…”

“…It is worth to remember, that depression correlates with life quality of patients: the relationship between psychosocial risk factors and cognitive disorders, which were combined with depression, anxiety, low psychosocial and socio-economic status in patients with CVD is proved [6,7].…”

Associação entre resiliência, sintomas depressivos e qualidade de vida de pacientes com insuficiência cardíaca crônica

“…Ao realizar a análise da associação da síndrome depressiva com a QV dos entrevistados, constatou-se em ambos os instrumentos aplicados que a pior QV esteve significantemente associada à presença de sintomas depressivos. Essa mesma relação foi encontrada em outros estudos, em que os achados evidenciaram que os sintomas de depressão e de ansiedade contribuem para piora da QV relacionada aos sintomas físicos da IC 15,31,32 .…”

Psychosomatic mechanisms of heart failure symptoms on quality of life in patients with chronic heart failure: A multi‐centre cross‐sectional study

“…Previous studies of symptoms in patients with CHF have focused on symptom clusters, but the findings do not reveal the relationship between different kinds of symptoms (Zhongfang et al., 2022). One study have indicated that heart failure symptoms can predict the quality of survival of CHF patients after 12 months, that is, the worse the heart failure symptoms, the poorer the quality of life (Kennedy, 2020); some studies have also demonstrated that physical symptoms can be influenced by depression and anxiety symptoms, and depression and anxiety symptoms can also exacerbate heart failure symptoms, leading to a poor quality of life in CHF patients (Figueiredo et al., 2020). In addition, psychological symptoms are associated with mortality and cardiovascular events, as well as with health‐related quality of life (Patron et al., 2017).…”