Abstract 14291: Depressive Symptoms are the Strongest Predictor of Anxiety Symptoms in Patients with Heart Failure

Abstract

Background: Patients with heart failure (HF) are at high risk for anxiety symptoms which predict HF rehospitalizations and worse physical functioning. Depressive symptoms may co-exist with anxiety symptoms. It is not known whether depressive symptoms independently predict the presence of anxiety symptoms in patients with HF.

Purpose: Determine whether depressive symptoms predict anxiety symptoms in patients with HF.

Methods: The sample consisted of 635 patients with HF (36% female, 62 ± 12 years, 87% outpatient, 56% NYHA class III/IV,) enrolled in a multicenter HF quality of life registry. The Brief Symptom Inventory-anxiety subscale, Beck Depression Inventory-II (BDI), Duke Activity Status Index, and NYHA functional class were assessed at baseline. Demographics, clinical characteristics, comorbidities, and medications were assessed by chart review. We used a cut-point of 0.35 (mean of healthy adults) to categorize patients as anxiety symptoms or no anxiety symptoms. We used logistic regression with simple forced entry to regress anxiety symptom status on age, gender, NYHA class, implanted cardiac defibrillator, functional activity status, depressive symptoms, and antidepressant use.

Results: The mean anxiety score was 0.72 ± 0.5, and 349 patients (55%) had anxiety symptoms, while 226 patients (36%) had depressive symptoms. Of those patients with anxiety symptoms, 89% (202) had comorbid depressive symptoms. The only independent predictors of anxiety were younger age (OR= 0.97, p = .004, 95% CI 0.96-0.99) and depressive symptoms (OR = 1.25, p < .001, 95% CI 1.19-1.31). The model explained 52% of the variance in anxiety symptoms (Nagelkerke R squared), and correctly classified 79% of cases. The strongest predictor of anxiety symptoms was depressive symptoms (standardized β = 0.22). For each 1-point increase on the Beck Depression Inventory-II, patients were 25% more likely to experience anxiety symptoms, after controlling for other variables in the model.

Conclusions: Patients with HF who have depressive symptoms are at very high risk for experiencing anxiety symptoms. Clinicians should assess these patients for comorbid anxiety symptoms, and researchers should test interventions that address both depressive and anxiety symptoms.