Prevalence, Temporal Change, and Determinants of Anxiety and Depression in Hospitalized Patients With Heart Failure

Highlights

• Symptoms of anxiety and depression were common in hospitalized patients with heart failure.

• Anxiety improved, whereas depression persisted during hospitalization for heart failure.

• Several patients’ characteristics were associated with worsening these symptoms.

Abstract

Background

Anxiety and depression may be under-recognized in patients with heart failure (HF). We therefore investigated the prevalence and temporal change of these symptoms in hospitalized patients with HF.

Methods and Results

We prospectively evaluated consecutive hospitalized patients with HF using the Hospital Anxiety and Depression Scale (HADS) on admission and at discharge. The HADS-A (anxiety) and HADS-D (depression) scores were categorized as follows; 0–7, no symptoms; 8–10, mild; and 11–21, significant anxiety or depression. Symptom worsening was defined as the HADS category at discharge being poorer than that on admission. Of 224 patients (mean age 77.5 years), 35 (16%) and 62 (28%) had significant symptoms of anxiety and depression, respectively. During hospitalization, the HADS-A significantly decreased (on admission; median 6 [interquartile range (IQR) 3–9] vs at discharge; median 4 [IQR 2–7], P < .01), whereas the HADS-D did not improve (on admission; median 8 [IQR 5–11] vs at discharge; median 8 [IQR 4–11], P =.82). Anxiety and depression worsened during hospitalization in 19 (10%) and 40 (21%) patients, respectively. Advanced age, higher natriuretic peptide levels, and acute-on-chronic HF were associated with worsening anxiety, and longer hospitalization length was associated with worsening depression.

Conclusions

Anxiety and depression were common and depression persisted during HF hospitalization.

Introduction

Heart failure (HF) is a chronic and progressive disease that becomes a major cause of morbidity and mortality.¹ Psychological issues, particularly emotional distress including anxiety and depression, are reported to be common and degrade the quality of life of patients with HF.^2,3 Psychological symptoms, especially depression, are also reportedly associated with a high mortality in these patients.⁴ However, psychological issues in patients with HF may be frequently underdiagnosed by health care professionals and insufficiently treated.⁵ In addition, most previous studies investigated the psychological symptoms only once during the course of HF,^6,7 and temporal changes of these symptoms have not been evaluated systematically.

Patients with HF are often repeatedly readmitted to the hospital.⁸ Hospitalization is an undesirable event for most patients with HF and can make these patients feel anxious and depressed. Meanwhile, HF hospitalization may be an ideal opportunity for psychological care because multidisciplinary interventions, such as cardiac rehabilitation and/or psychiatric management, which are considered to be effective for psychological symptoms, can be introduced easily during hospitalization. To date, there is a lack of studies addressing the course of psychological symptoms during hospitalization for HF. An understanding of the prevalence and temporal changes of anxiety and depression, as well as the determinants of exacerbation of these symptoms, may be of clinical value and form the foundation for the psychological management of hospitalized patients with HF in the future.

Accordingly, the aim of this study was to investigate the prevalence, temporal changes, and determinants of symptoms of anxiety and depression in consecutive hospitalized patients with HF in a Japanese cardiovascular department. We hypothesized that both symptoms of anxiety and those of depression can be relieved during hospitalization for HF.