Abstract 2734: Comorbid Anxiety and Depression: The Dynamic Duo of Death
Background: Depression and anxiety have been associated separately with increased mortality in coronary heart disease (CHD) patients, but their combined effect is not well understood. The purpose of this study was to determine the effect of persistent dysphoria (anxiety, depression or both) on all-cause mortality in CHD patients.
Methods: All participants had confirmed CHD and were enrolled in a randomized controlled trial to reduce prehospital delay for acute coronary syndrome symptoms (PROMOTION). Those who completed baseline and 3 month mood checks (via Multiple Affect Adjective Checklist [MAACL] for depression and Brief Symptom Inventory [BSI] for anxiety) were included (n = 2325, 31.1% female, aged 67.2 ± 10.7 years). Using baseline and 3 months checks, patients were classified as not dysphoric (MAACL < 11 and BSI < .33) or persistently depressed (MAACL >= 11), anxious (BSI <= .33), or both, and were followed for a median of 21.6 months. Deaths were confirmed by medical record or death certificate. Data were analyzed by multivariable Cox regression, with demographic and clinical variables, group assignment (intervention or control) in the parent study, and dysphoria status forced in the model.
Results: There were 63 deaths (2.7%), of which 23 were cardiac-related. Comorbid anxiety/depression (26.2%) was more common than either depression (19.3%) or anxiety (16.3%) alone. Of the dyphoric states, only comorbid anxiety/depression contributed significantly to all-cause mortality.
Conclusions: In CHD patients, comorbid anxiety/depression is both common and associated with increased risk of death. Assessing for both and making appropriate referrals is recommended.