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(Circulation. 2004;110:3452-3456.)
© 2004 American Heart Association, Inc.

Heart Failure

Prognostic Value of Anxiety and Depression in Patients With Chronic Heart Failure

Wei Jiang, MD; Maragatha Kuchibhatla, PhD; Michael S. Cuffe, MD; Eric J. Christopher, MD; Jude D. Alexander, MD; Greg L. Clary, MD; Michael A. Blazing, MD; Laura H. Gaulden, MS; Robert M. Califf, MD; Ranga R. Krishnan, MD; Christopher M. O’Connor, MD

From the Department of Psychiatry and Behavioral Sciences (W.J., E.J.C., G.L.C., R.R.K.), Aging Center (M.K.), and Department of Medicine (W.J., M.S.C., E.J.C., G.L.C., M.A.B., L.H.G., R.M.C., C.M.O.), Duke University Medical Center, Durham, NC, and Medicine/Psychiatry Services (J.D.A.), Shady Grove Adventist Hospital, Rockville, Md.

Correspondence to Wei Jiang, MD, Box 3366, Duke University Medical Center, Durham, NC 27710. E-mail jiang001{at}mc.duke.edu

Received May 20, 2004; revision received September 20, 2004; accepted September 30, 2004.

Background— Anxiety is often present with depression and may be one of its manifestations. Although the adverse effects of depression in patients with chronic heart failure (CHF) have been well studied, the relation between anxiety and CHF prognosis has not been addressed. In a secondary analysis of data collected for a published study of depression and prognosis in patients with CHF, we examined the relations among anxiety, depression, and prognosis.

Methods and Results— We measured symptoms of anxiety with the Spielberger State-Trait Anxiety Inventory (STAI) scale and symptoms of depression with the Beck Depression Inventory (BDI) scale in 291 patients with CHF hospitalized as a result of cardiac events. We followed up these patients for all-cause mortality over 1 year. The mean scores for state anxiety (State-A) and trait anxiety (Trait-A) were identical at 33.5; the mean BDI score was 8.7±7.6. State-A and Trait-A scores correlated highly with each other (r=0.85; P<0.01) and with BDI score (State-A, r=0.52; Trait-A, r=0.59; P<0.01). Cox proportional-hazards model with and without confounding variables showed no relation between State-A or Trait-A and 1-year mortality. BDI scores, however, significantly predicted increased mortality during 1-year follow-up (hazard ratio, 1.04 for each 1-unit increase; P<0.01).

Conclusions— Although anxiety and depression are highly correlated in CHF patients, depression alone predicts a significantly worse prognosis for these patients.

Key Words: anxiety • depression • heart failure • prognosis

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