Association of Anxiety and Depression With All‐Cause Mortality in Individuals With Coronary Heart Disease

Abstract

BackgroundDepression 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 ResultsThe 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).ConclusionsAnxiety 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.

Translation and validation of the Cardiac Depression Scale to Arabic

“…Although the difference in the correlations may not be clinically significant, it suggests that there was a comorbidity of depression and anxiety in our sample. This may have two not mutually exclusive explanations: a) The comorbidity of depression and anxiety is evident worldwide (Kessler et al, 2015) and in the Arabic population specifically (Al-Turkait et al, 2011;Belzer and Schneier, 2004;Ohaeri et al, 2010) and b) there is evidence that depression is correlated to anxiety in patients with heart disease (Frasure-Smith et al, 1995;Watkins et al, 2013) and this comorbidity can affect between 21% to 26% of the patients (Doering et al, 2010;Frasure-Smith and Lesperance, 2008). Both explanations support the validity of the A-CDS.…”

A Narrative Review of the Relationship Between Coronary Heart Disease and Anxiety

“…Also, in another study, persistence of comorbid depression and anxiety was noted to significantly contribute to mortality (32). In addition, a recent 3-year follow-up study revealed that anxiety and depression were both independently associated with the increased risk of mortality, and cooccurrence of these conditions showed an additive 3-fold increased risk (33).…”

Quality of Life and Psycho-Cognitive Condition in Patients After Coronary Artery Bypass Graft Surgery

“…Состояние дистресса, которое неизбежно испытывает больной, перенесший технически сложное и длительное опера-тивное вмешательство, может сопровождаться аффек-тивными расстройствами, которые не только в 2-3 раза повышают риск смерти и усугубляют клиническое тече-ние послеоперационного периода, но и снижают при-верженность пациента к врачебным рекомендациям [7,8]. Расстройства тревожно-депрессивного спектра также могут существенно ухудшать качество жизни больных [9], значительно снижая, тем самым, эффект дорогосто-ящего оперативного лечения.…”

“…Нарастание когнитивных расстройств, напротив, приводило к снижению тревоги, что под-тверждается выявленной отрицательной корреляци-онной связью между показателями шкал MMSE и HARS (r=-0,35; р<0,05). Как и у прочих больных с сердечно-сосудистыми заболеваниями [8] у иссле-дуемых пациентов отмечалась коморбидность тре-воги и депрессии (r=0,91; p<0,05). Тревога и депрес-сия (ГШТД) закономерно снижали удовлетворен-ность больных, перенесших АКШ, своим КЖ (r=-0,53; p<0,05, r=-0,52; p<0,03).…”