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Health & Medicine for Senior Citizens

Depression, Anxiety a Deadly Combination for Older People with Heart Disease

Two new studies look at anxiety and depression among older heart disease patients and find these patients need closer monitoring

March 20, 2013 — Heart disease patients who have anxiety have twice the risk of dying from any cause compared to those without anxiety. It they suffer both anxiety and depression they have a triple risk of dying. Then, a second study finds heart failure patients with moderate or severe depression have four times the risk of dying.

The study of anxiety and depression among older heart disease patients was released in the Journal of the American Heart Association. The new research on depression and heart failure patients with an average age of 72 is reported in Circulation: Heart Failure, an American Heart Association Journal.

Study 1: Increased monitoring needed for heart patients with anxiety and depression

“Many studies have linked depression to an increased risk of death in heart disease patients,” said Lana Watkins, Ph.D., lead author of the study and an associate professor in Psychiatry and Behavioral Sciences at Duke University Medical Center in Durham, N.C.  “However, anxiety hasn’t received as much attention.”

Studies show that depression is about three times more common in heart attack patients.  The American Heart Association recommends that heart patients be screened for depression and treated if necessary.

 

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Depressed heart disease patients often also have anxiety, suggesting it may underlie the risk previously attributed solely to depression, Watkins said. “It’s now time for anxiety to be considered as important as depression, and for it to be examined carefully.”

In the study, 934 heart disease patients, average age 62, completed a questionnaire measuring their level of anxiety and depression immediately before or after a cardiac catheterization procedure at Duke University Medical Center. Patients had anxiety if they scored 8 or higher on a scale composed of seven common characteristics of anxiety, with each item rated from 0 to 3 (range of possible scores: 0-21).  Depression was measured using a similar scale composed of seven symptoms of depression.

Researchers, after accounting for age, congestive heart failure, kidney disease and other factors that affect death risk, found:

     90 of the 934 patients experienced anxiety only,
     65 experienced depression only and
     99 suffered anxiety and depression.

Among 133 patients who died during three years of follow-up, 55 had anxiety, depression or both. The majority of deaths (93 of 133) were heart-related.

Researchers measured anxiety and depression during cardiac catheterization because levels better reflected how patients normally handle stressful situations.

Anxiety and depression each influence risk of death in unique ways. Anxiety, for example, increases activity of the sympathetic (adrenaline-producing) nervous system that controls blood pressure.

“People who worry a lot are more likely to have difficulty sleeping and to develop high blood pressure,” Watkins said.

The link between depression and mortality is more related to behavioral risk factors, she said. “Depression results in lack of adherence to medical advice and treatments, along with behaviors like smoking and being sedentary.”

Future studies should test strategies to manage anxiety alone and with depression in heart disease patients, Watkins said.

“Anxiety reducing medications combined with stress management could improve outcome for patients with just anxiety, whereas patients with anxiety and depression may need a stronger intervention involving more frequent outpatient monitoring and incentives to improve adherence,” she said.

Co-authors are: Gary G. Koch, Ph.D.; Andrew Sherwood, Ph.D.; James A. Blumenthal, Ph.D.; Jonathan R.T. Davidson, M.D.; Christopher O’Connor, M.D.; and Michael H. Sketch Jr., M.D. Author disclosures are on the manuscript.

The National Institutes of Health funded the study.

For more information about the role anxiety and depression play in heart disease, visit depression screening in heart patients.


Study 2: Heart failure patients with depression have four times risk of death

March 19, 2013 — Heart failure patients who are moderately or severely depressed have four times the risk of dying and double the risk of having to go to the emergency room or be hospitalized compared to those who are not depressed, according to new research reported in Circulation: Heart Failure, an American Heart Association Journal.

“Depression is a key driver of healthcare use in heart failure,” said Alanna M. Chamberlain, Ph.D., M.P.H., the study’s lead author and assistant professor of epidemiology in the Department of Health Sciences Research at the Mayo Clinic in Rochester, Minn. “Treatment programs should be tailored to each patient’s needs with greater emphasis on managing depression either through medication or lifestyle interventions.”

In 2007-10, 402 heart failure patients (58 percent male, average age 73) in three Minnesota counties completed a nine-question survey. Based on the answers, 59 percent of patients were classified as having no depression, 26 percent had mild depression and 15 percent had moderate-to-severe depression. Researchers gathered information on the participants for about a year and a half.

Even those who reported mild depression had almost a 60 percent increased risk of death, but a much smaller increased risk of emergency room visits (35 percent) and hospitalizations (16 percent), researchers found.

Because the patients studied were mostly white and lived in southeastern Minnesota, the results may not apply to all heart failure patients throughout the United States, researchers said only a third of the patients with moderate-to-severe depression were taking antidepressant medication. Depression may be under-diagnosed in these patients; however, some may have been undergoing therapy that didn’t include prescription drugs, researchers said.

“We measured depression with a one-time questionnaire so we cannot account for changes in depression symptoms over time,” Chamberlain said. “Further research is warranted to develop more effective clinical approaches for management of depression in heart failure patients.”

Co-authors are: Amanda R. Moraska, B.A.; Nilay D. Shah, Ph.D.; Kristin S. Vickers, Ph.D.; Teresa A. Rummans, M.D.; Shannon M. Dunlay, M.D., M.Sc.; John A. Spertus, M.D., M.P.H; Susan A. Weston, M.S.; Sheila M. McNallan, M.P.H.; Margaret M. Redfield, M.D.; and Veronique L. Roger, M.D., M.P.H. Author disclosures are on the manuscript.

The National Heart, Lung, and Blood Institute and the National Institute on Aging funded the study.

For additional information on heart failure and depression, visit: http://newsroom.heart.org/news/depression-in-heart-failure-patients-233191.

For the latest heart and stroke news, follow on Twitter: @HeartNews.

 

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