on November 22, 2004
Published online before print November 22, 2004, doi: 10.1161/01.CIR.0000148138.25157.F9
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Submitted on May 20, 2004
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. * To whom correspondence should be addressed. E-mail: jiang001{at}mc.duke.edu.
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.
Revised on September 20, 2004
Accepted on September 30, 2004
Prognostic Value of Anxiety and Depression in Patients With Chronic Heart Failure
Wei Jiang MD*,
Key words: anxiety • depression • heart failure • prognosis
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