Anxiety and Poor Social Support are Independently Associated With Adverse Outcomes in Patients With Mild Heart Failure

Abstract

Background The impact of psychosocial states, such as depression or anxiety, and social support on the outcomes of stable outpatients with mild heart failure (HF) has not been evaluated in the "real world" clinical practice. Methods and ResultsIn the present study, 139 patients with a prior history of admission for HF provided the baseline demographic, clinical, socio-environmental, and psychosocial information. Cardiac death or re-admission because of worsening of HF was monitored during the follow-up period of 1 year. The prevalence of depression and anxiety were 37% and 37%, respectively, in HF patients. Depression was independently associated with male (sβ=-0.36, P=0.01), social ties (sβ=0.22, P=0.04) and low social support (sβ=-0.39, P<0.01). Anxiety was associated with alcohol drinking (sβ=0.22, P=0.04), brain natriuretic peptide ≥200 pg/dl (sβ=0.35, P<0.01), and low social support (sβ=-0.28, P=0.01). Kaplan-Meier analysis demonstrated that patients with anxiety (log-lank test; P<0.01) and lower scores of social support (P<0.01) had a higher rate of HF-related re-admission. Conclusions Anxiety and low social support were independently associated with HF-related re-admission, which indicates the need for their inclusion in the assessment and management of HF. (Circ J 2009; 73: 280 -287)

Depression and Outcomes in Hospitalized Japanese Patients With Cardiovascular Disease - Prospective Single-Center Observational Study -

“…Poor social support also has been reported to be independently associated with worse cardiovascular outcome. 60 Second, biological mechanisms are involved in poor cardiovascular outcomes. Several events have been associated with these poor outcomes, including changes in cardiac autonomic tone, activation of the sympathetic nervous system, enhanced activity of the hypothalamic-pituitary-adrenal axis, and elevated inflammatory and pro-inflammatory processes.…”

Hospital readmission in heart failure, a novel analysis of a longstanding problem

“…The severity of depression has been shown to be an independent predictor of non-compliance [46], readmission [45] and mortality in heart failure when controlling for established risk factors [47,48]. Anxiety, often comorbid with both depression and heart failure, was also shown to predict hospital readmission [49].…”

Avoidant coping moderates the association between anxiety and patient-rated physical functioning in heart failure patients

“…Reported rates have ranged from 20% for diagnostic clinical interview criteria to approximately 45% for symptoms measured with a self-report questionnaire (Haworth et al, 2005;Friedmann et al, 2006). Despite these high prevalence rates, few studies have examined how anxiety affects the progression of heart failure (Clarke et al, 2000;Cully et al, 2009;Friedmann et al, 2006;Tsuchihashi-Makaya et al, 2009). The available studies have described an association between higher anxiety and more limitations in activities of daily living (Clarke et al, 2000), poorer physical quality of life (Volz et al, 2011), greater impairment in functional status (Friedmann et al, 2006), higher medical service use (Cully et al, 2009), and more re-hospitalizations (Tsuchihashi-Makaya et al, 2009;Volz et al, 2011) in patients with chronic heart failure.…”

“…Despite these high prevalence rates, few studies have examined how anxiety affects the progression of heart failure (Clarke et al, 2000;Cully et al, 2009;Friedmann et al, 2006;Tsuchihashi-Makaya et al, 2009). The available studies have described an association between higher anxiety and more limitations in activities of daily living (Clarke et al, 2000), poorer physical quality of life (Volz et al, 2011), greater impairment in functional status (Friedmann et al, 2006), higher medical service use (Cully et al, 2009), and more re-hospitalizations (Tsuchihashi-Makaya et al, 2009;Volz et al, 2011) in patients with chronic heart failure. In contrast, a few studies did not find an association between anxiety and hospitalizations (Konstam et al, 1996) or mortality in heart failure patients (Konstam et al, 1996;Jiang et al, 2004;Friedmann et al, 2006).…”