Prevalence, Temporal Change, and Determinants of Anxiety and Depression in Hospitalized Patients With Heart Failure
Graphical abstract
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.
Section snippets
Study Population
This single-center HF registry is an ongoing, prospective, observational study including consecutive patients hospitalized for HF at the National Hospital Organization Kyoto Medical Center, Kyoto, Japan. The diagnosis of HF was confirmed based on the Framingham definition of HF by 2 or more cardiologists at a conference at the cardiology department of the hospital.9 The objective of this registry was to evaluate the current status of total pain (such as physical, psychological, social, and
Study Flowchart and Baseline Characteristics
A flowchart of this study is presented in Fig. 1. Of the 298 total patients with HF hospitalized at our institution between October 2019 and January 2021, 224 (75%) completed the HADS questionnaires on admission. Of 224 patients, the mean age was 77.5 ± 12.4 years and 131 (58%) were male. There were 75 patients classified as New York Heart Association functional class IV (33%), the median NT-proBNP level was 4527 pg/mL, and the mean left ventricular ejection fraction was 44% on admission (Table
Discussion
In this study, we investigated the current status of the prevalence and temporal changes of symptoms of anxiety and depression in contemporary hospitalized patients with HF. A questionnaire survey for consecutive patients with HF revealed the following. First, both symptoms of anxiety and depression were commonly observed in hospitalized patients with HF. Second, symptoms of anxiety improved during HF hospitalization to some extent, whereas depression did not improve significantly. Third, we
Conclusions
Anxiety and depression were common in hospitalized patients with HF, and depression did not improve during hospitalization for HF. We found several risk factors, such as advanced age, higher natriuretic peptide levels, acute-on-chronic HF, and longer hospitalization length, for the worsening of these symptoms. Further studies are warranted to investigate the utility of screening and intervention for psychological symptoms in hospitalized patients with HF.
Disclosures
All authors reported that they have no relationships relevant to the content of this article to disclose.
Funding
This study was supported by SASAKAWA Health Foundation, and the Japan Agency for Medical Research and Development under grant 19ek0210128h0001.
Acknowledgments
The authors sincerely appreciate the efforts of the clinical research coordinator (M. Fukahori) and the medical staff of National Hospital Organization Kyoto Medical Center (K. Minami, K. Ishigami, S. Ikeda, K. Doi, T. Yoshizawa, Y. Ide, A. Fujino, M. Ishii, H. Ogawa, M. Masunaga, and M. Abe).
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