Anxiety and Depression Coupled With Heart Disease Triples the Risk of Death

Duke University Medical Center recently published the results of a study on the role of anxiety and depression on heart disease.  [1]The study involved 934 patients who were carefully screened to make sure they met the criteria that the researchers were using for this study.  The researchers pulled data from the patient’s charts that included medical history, current diagnoses, medications, blood pressure, and the patient’s current coronary disease treatment plan.

The researchers used a modified version of the Stanford 7 -day physical activity recall interview  to estimate physical activity and habitual sleep duration during the 7 day period prior to hospitalization. They also included a left ventricular ejection fraction (LVEF) and degree of coronary artery stenosis from the cardiac catheterization report. Finally they added the education status and smoking status through patient interviews.

The researchers then used the Hospital Anxiety and Depression Scale (HADS). This is a 14-item self-report questionnaire comprising 4-point Likert-scaled items measuring the occurrence of symptoms of anxiety (HADS-A) and depression (HADS-D) over the previous 2 weeks. At the completion of the HADS questionnaire of the 934 patients, 928 had no missing items, and 6 had only 1 missing item, and this was replaced using the mean score of the other items on the sub-scale in question.

The researchers continued to follow up with the patients and they were contacted by mail at 6 months and annually thereafter up to 4 years after the initial assessment to document hospitalizations and vital status. If a patient was deceased then the researchers tried to gather discharge summaries, clinic notes, and supporting documentation (EKG and laboratory results) for each cardiac-related re-hospitalization during the follow-up period. If the medical records were inconclusive then the researchers tried to follow up with survivors of the deceased for more information. Over a three year period there were 133 deaths that occurred among the original 934 patients.

The conclusions reached at the end of the study were that clinicians need to assess patients for both anxiety and depression and continue to monitor these symptoms on a regular basis. Anxiety and depression coupled with heart disease triples the risk of death compared to cardiac trouble alone.[2] Patients suffering from anxiety can increase inflammation and blood pressure. Patients who exhibit or suffer with feelings of worthlessness associated with depression may ignore their treatment for heart disease.  Previous studies have focused more on depression and have not included anxiety as a second risk factor. Patients who have elevated anxiety, particularly when found in the context of comorbid depression, may benefit from treatment of anxiety and from more intensive monitoring.