2017

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2017/№4

Patients with chronic heart failure. Who are the candidates for anxiety and depression?

Drobizhev M. Yu.1, Mareev V. Yu.2, Begrambekova Yu. L.2
1 – I. M. Sechenov First Moscow State Medical University, Trubetskaya 8, Bldg. 2, Moscow 119991
2 – M. V. Lomonosov Moscow State University, Leninskie Gory 1, GSP-1, Moscow 119991

Keywords: heart failure, depression, anxiety

DOI: 10.18087/rhfj.2017.4.2374

Objective. To identify the clinical features of chronic heart failure (CHF) that can be qualified as independent risk factors for depression and/or anxiety symptoms in patients enrolled in the Society of Heart Failure Specialists School and Outpatient Monitoring of CHF (CHANCE) patients for depression and anxiety. Material and methods. The CHANCE study population was divided into 4 subgroups, depending on the results of the Hospital Anxiety and Depression Scale (HADS) base testing. The groups were as follows: "T" with symptoms of anxiety (HADS(a) ≥11, and HADS(d) <11); "D" - with symptoms of depression (HADS(d) ≥11, and HADS(a) <11); "D&T" - with symptoms of depression and anxiety (≥11); "Norm" - without clinical evident symptoms of anxiety and depression (HADS(d) and HADS(a) <11). With the help of the T-test and Pearson's χ2, different clinical parameters were compared (the duration of CHF, etiology, the scale of assessment of the clinical state according to V. Yu. Mareev - SHOKS, six-minute walking test - 6МWT, the functional class - FC CHF, the left ventricular ejection fraction %) in these groups. When significant differences (p<0.05) were distinguished with the help of multiple logit regression analysis, it was checked whether a particular clinical indicator could be considered as an independent factor influencing the formation of depression and/or anxiety, taking into account the influence of other CHF parameters, and also sex and age of patients. Results. Independent association with anxiety (p<0.05) is found in the sum of scores (8.0±3.1) according to SHOKS (OR 1.12, 95% CI 1.01-1.23), percentage (in%) of men (0.50, 95% CI 0.28-0.87); With depression in the sum of scores (9.2±3.5) according to SHOCK (1.19, 1.09-1.31), the percentage (in%) of men (0.53, 95% CI 0.32-0.87) and Age (OR 1.03, 95% CI 1.01-1.06); With depression and anxiety in the sum of scores (10.5±3.5) according to SHOCS (1.41, 95% CI 1.22-1.63), percentage (in%) of men (0.24, 95% CI 0.11-0.54). Conclusion. The SHOCS scores (along with gender and age) is independent prognostic factor for anxiety, depression, or a combination of depression and anxiety symptoms development in patients with CHF. One more confirmation has been received that depression and/or anxiety is most likely a psychiatric complication of CHF caused by a patient's adaptation to cardiovascular pathology. The sum of SHOCS scores (along with demographic indicators) can be used to predict the occurrence or reduction of depression and/or anxiety symptoms in patients with CHF and is an interesting integrative indicator that allows to combine the objective (cardiological survey data) and subjective (patient's opinion) assessment of CHF severity.
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Drobizhev M. Yu., Mareev V. Yu., Begrambekova Yu. L. Patients with chronic heart failure. Who are the candidates for anxiety and depression? Russian Heart Failure Journal. 2017;18(4):295–302

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