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Effects of depression and anxiety on clinical outcomes in patients with CHF

Drobizhev M. Yu.1, Begrambekova Yu. L.2, Mareev V. Yu.2, Kikta S. V.3
1 – State Budgetary Educational Institution of Higher Professional Education “I. M. Sechenov First Moscow State Medical University” of the RF Ministry of Health Care, Trubetskaya 8, Bldg. 2, Moscow 119991
2 – Federal State Budgetary Educational Institution of Higher Professional Education “M. V. Lomonosov Moscow State University”, Leninskie Gory 1, GSP-1, Moscow 119991
3 – Federal State Budgetary Institution, “Polyclinic #3” of the Department for Presidential Affairs of the Russian Federation, Grokholsky Pereulok., 31, Moscow 129090

Keywords: CHF, depression, anxiety, prognosis, mortality, hospitalisation

DOI: 10.18087/rhfj.2016.2.2206

Background. Many studies have demonstrated an independent effect of depression on HF prognosis. Most Western expert societies recommend to routinely screen for depression patients with cardiovascular diseases to refer them subsequently to a psychiatrist for treatment. However, convincing evidence for an effect of these interventions on the HF course are still not available. Aim. To study effects of depression and anxiety on mortality and hospitalization rate of CHF patients using a complex monofactorial and multifactorial analysis. Materials and methods. Using a mono- and then multifactorial statistical analyses we determined independent effects of depression and anxiety on prognosis for HF patients with NYHA Class III-IV included in the CHANCE study. The included patients were tested using a Hospital Anxiety and Depression Scale (HADS) at study week 0, and their demographic and clinical characteristics were recorded at the same time. Results. Using methods of the monofactorial analysis we studied the relationship between the following independent, mental status variables with mortality and hospitalizations: mean score of the HADS anxiety subscale; mean score of the HADS depression subscale; proportion of patients with anxiety; proportion of patients with moderate and severe depression; and proportion of patients with moderate and severe anxiety and depression. A significant relationship with mortality was found for the mean score of the HADS depression subscale with OR 1.09 [95 % CI 1.02–1.16] and proportion of patients with anxiety and depression with OR 1.24 [95 % CI 1.04–1.48]. None of the studied mental parameters showed a statistically significant relationship with hospitalization. The multiple logistic regression, in addition to mental factors, included clinical and demographic parameters that had shown the greatest impact on mortality in the monofactorial analysis: presence of a patient in the active group (OR 0.61 [95 % CI 0.37–0.99]); postinfarction cardiosclerosis (OR 2.54 [95 % CI 1.50–4.28]); CHF stage (OR 2.88 [95 % CI 1.86–4.46]); NYHA FC (OR 4.13 [95 % CI 2.54–6.72]); depression and a combination of depression and anxiety. When included into the multiple logistic regression, the parameters of mental status lost their relationship with mortality. Conclusion. This study did not demonstrate an independent effect of depressive and anxiety disorders on hospitalization and mortality of HF patients with NYHA FC III-IV.
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Drobizhev M. Yu., Begrambekova Yu. L., Mareev V. Yu., Kikta S. V. Effects of depression and anxiety on clinical outcomes in patients with CHF. Russian Heart Failure Journal. 2016;17 (2):91–98

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