Journal of Experimental Medical & Surgical Research

Cercetãri Experimentale & Medico-Chirurgicale

JOURNAL of
Experimental
Year XVII · Nr.2/2010 · Pag.148 - 151
Medical Surgical
R E S E AR C H

ANXIETY, DEPRESSION AND QUALITY OF LIFE IN

HEART FAILURE PATIENTS
S. Laicu1, SUMMARY: Aim. It is assumed that there is a degree of psychiatric disease in cardiac patients, in
R. Avram1, connection with clinical symptoms and functional limitation, but possible with a poor quality of
S. Tãmãºan2, life, too. We tried to identify anxiety, depression and quality of life in patients (p.) with or without
heart failure and the correlation with clinical parameters.
D. Jejeran2,
Material and Method. We studied a number of 63 p. without a previous psychiatric diagnosis,
T. Ciocârlie1, emergency admitted with cardiac failure. We recorded demographic data and clinical – para
F. Pârv1, clinical data into grades of severity. For psychiatric evaluation we used Hamilton scales (HAM)
M. Balint1, for anxiety (noted 18, 25, 30) and depression (medium 18), the HADS scale for anxiety and
V. Moga1, depression in hospital (7-10, =>11), respectively; the quality of life (S-QC), social support
D. Pãscuþ1 (S-SS), health state and quality of health care (S-HS) were evaluated through OMS scale (noted
1-10).
Results. In the global lot recorded through 2 tests: anxiety in 34.91% as follows - moderate (noted
18-25) in 12p. (19.04%), severe (>25) in 10p. (15.87%) and 42.86% respectively though HADS,
depression in 31.74% and 28.7% p, respectively. Clinical classification of HF correlates with S-QC
(p<0,005), with S-SS (p<0,05), EF vs. S-QC (p<0,01) and vs. S-SS (p<0,0001), and the 6
minutes walk test vs. S-SS - p<0,01, vs. S-QC p<0,001, respectively.
Conclusions. Anxiety and depression are present in more than 1/3p., with a strong correlation
with the heart failure’s severity. Subjective data regarding the quality of life and social support
are in relation with clinical severity and the alteration of EF in heart failure p. The prevalence of
psychiatric pathology, correlation with the quality of life, justifies the research and action on
psycho – social factors.

Key Words:

ANXIETATEA, DEPRESIA ºI CALITATEA VIEÞII LA PACIENÞII CU INSUFICIENÞÃ

CARDIACÃ

Received for publication:
10.07.2010
Revised: 11.07.2010
1. - County Hospital Timisoara, Department of Cardiology, 2. - County Hospital Timisoara, Department of Psychiatry
Rezumat: Scopul lucrãrii. Este de presupus ca la pacienþii cardiaci sã existe un grad de afectare
psihicã, în legãturã cu simptomatologia clinicã ºi limitarea funcþionalã, posibil însã ºi cu o calitate
a vieþii alteratã. Ne-am propus identificarea anxietãþii, depresiei ºi evaluarea calitãþii vieþii la
pacienþii (p) cu ºi fãrã insuficienþã cardiacã ºi corelarea cu parametrii clinici.
Material ºi Metodã. Am studiat un numãr de 63 pacienþi nediagnosticaþi cu boalã psihiatricã,
internaþi de urgenþã cu insuficienþã cardiacã (IC). S-au înregistrat datele demografice ºi de
încadrare clinicã-paraclinicã în grade severitate. Pentru evaluarea psihiatricã s-au utilizat scalele
Hamilton (HAM) pentru anxietate (notatã cu 18, 25, 30) ºi depresie (medie 18) respectiv scala
HADS de anxietate ºi depresie în spital (7-10 ºi =>11), calitatea vieþii (S-QC), suportul social
(S-SS), starea de sãnãtate ºi calitatea îngrijirii (S-HS) s-au apreciat prin scala OMS (cotaþii 1-10).
Rezultate. În lotul global s-au înregistrat prin cele 2 teste: anxietate la 34,91% ºi anume moderatã
(notatã 18-25) la 12p. (19,04%), severã (>25) la 10p. (15,87%) ºi respectiv 42,86% prin HADS;
depresia s-a confirmat la 31,74%. Încadrarea clinicã a IC se coreleazã cu S-QC (p<0,005), cu
S-SS (p<0,05), FE vs. S-QC (p<0,01), respectiv vs. S-SS (p<0,0001), iar testul de mers 6 minute
vs. S-SS - p<0,01, respectiv vs. S-QC - p<0,001.
Concluzii. Anxietatea ºi depresia sunt prezente la peste 1/3 din p., corelate mai ales cu
severitatea insuficienþei cardiace. Datele subiective privind calitatea vieþii ºi suportul social sunt
modificate mai ales în relaþie cu gravitatea clinicã ºi alterarea FE în IC. Incidenþa patologiei
psihiatrice, relaþia cu calitatea vieþii justificã cercetarea ºi acþiunea asupra factorilor
psiho-sociali.

Correspondence to: Simina Laicu , e-mail: siminalaicu18@yahoo.com

148
 health care (S-HS) were evaluated through OMS scale
AIM (noted 1-10). We correlated, and classified in sub groups,
It is assumed that there is a degree of psychiatric the resulted psychiatric scores with the severity of
disease in cardiac patients, in connection with clinical clinical disease and with the degree of systolic
symptoms and functional limitation, but possible with a dysfunction, measured by echocardiography with the
poor quality of life, too. We tried to identify anxiety, Siemens Echocardiograph. Standard 6 minutes test was
depression and quality of life in patients (p.) with or also used in all patients.
without heart failure and the correlation with clinical
RESULTS AND DISCUSSIONS
parameters.
In the global lot recorded through 2 tests we found:
MATERIAL AND METHOD anxiety in 34.91% as follows - moderate (noted 18-25) in
We studied a number of 63 p. without a previous 12p. (19.04%), severe (>25) in 10p. (15.87%) and
psychiatric diagnosis, emergency admitted with cardiac 42.86% respectively though HADS (fig.1), depression in
failure. We recorded demographic data and clinical – 31.74% and 28.7% p, respectively (fig.2).
paraclinical data into grades of heart failure severity. For As to the gender, 68% were men and 32% women,
psychiatric evaluation we used Hamilton scales (HAM) approximately the same incidence (fig.3). Patients over
for anxiety (noted 18, 25, 30) and depression (medium 60 years old being more (fig.4). As to the home location
18), the HADS scale for anxiety and depression in this was mainly urban -60% for depression and 75% for
hospital (7-10, =>11), respectively; the quality of life anxiety. Depression had a double incidence in over 70
(S-QC), social support (S-SS), health state and quality of years old p. from urban location.

Fig.1 The incidence of anxiety evaluated in p. with heart failure

Fig.2 The incidence of depression in p. with heart failure

149
 Fig 3Gender and the incidence of psychiatric disorders

Fig.4 The incidence of psychiatric disorders in p>60 years old

Clinical classification of HF correlates with S-QC angina components determining idiopathic

(p<0,005), with S-SS (p<0,05), EF vs. S-QC (p<0,01) cardiomyopathy.
and vs. S-SS (p<0,0001), and the 6 minutes walk test vs. Depression exacerbates and amplifies cardiac
S-SS - p<0,01, vs. S-QC p<0,001, respectively. symptoms and in the mean time effects compliance to
The parameters of quality of life and social support are medical treatment. Between 26-17% of cardiac patients
clearly correlated to the symptoms of cardiac failure. suffer from depression at a follow up between 6 months
Ejection fraction is especially connected to the existence and 4.5 years (1).
of a social support, suggesting the necessity of a The socio economic status has an important
sustained effort in educating the family or of organizing significance, evident in relation to education and income,
some other type of support through social organizations here being also suggested a relation to inflammatory
and locations. elements, like C-reactive protein (2).
The 6 minute test remains a important test with an In patients with cardiac failure there is a percentage of
undeniable impact. 48 registered with depression, predominantly in women,
Anxiety, panic attack and phobic anxiety constitutes more frequently in the black population which registered
risk elements for the cardiac parameters, enabling the a low QOL.
development of atherosclerotic plaques starting from the The data from the literature suggest a relation between
intima media thickness to non fatal myocardial infarction, the incidence of depression and the degree of cardiac
and a mortality risk, respectively. The mechanisms are failure severity 11% in class I NYHA and 42% in class IV
related to the sympathetic nervous system with the NYHA(1).
overproduction of cathecolamines but also to the The studies regarding prognosis suggest that
reduction of vagal activity and to the microvascular depression has a particularly negative impact possibly

150
regarding the personality profile, and not only in
correlation to the severity of the disease (4). After CONCLUSIONS
myocardial infartion patients with depression seem to Anxiety and depression are present in more than
have a more reserved prognosis than those without 1/3p., with a strong correlation with the heart failure’s
depression (5), and the risk of sudden death being severity. Subjective data regarding the quality of life and
2.67%(6). social support are in relation with clinical severity and the
Considering the relation between anxiety and alteration of EF in heart failure p; 6 minutes walk test
depression, it is interesting to note that only depression seems to be an excellent test to evaluate the quality of
seems to have negative impact (7); in p. deceased after life parameters. Older patients from urban were more
myocardial infarction, depression was present in 16% frequent depressives and more vulnerable to psychiatric
and in 7.6% of the survivors(8). disease especially those with a lower QOL score.
Psychiatric diseases associated or preceding cardiac Depression is under recognized and under treated within
disease, influence and interact with prognostic, cardiovascular population, recognition and treatment
especially depression which is responsible for therapy may lead to an improvement of patient outcomes. The
non adherence(9). prevalence of psychiatric pathology, correlation with the
In the same time, even the cardiac-vascular quality of life, justifies the research and action on psycho
medication is disseminated to favor depression – such as – social factors.
betablocker drugs(10).

REFERENCES
1. Rutledge T - Depression in Heart Failure – JACC 2006;48:1527-37
2. Lubbock L – Relation of Low Socioeconomic Status to C-Reactive Protein in Patients with Coronary Heart Disease – Am. J.
Cardiol. 2005;59:1506-1510
3. Gottlieb S.S. – The Influence of Age, Gender and Race on the Prevalence of Depression in Heart Failure Patients – JACC
2006;43:1542-9
4. Stork S. – Depressive Symptoms and Quality of Life Predict Short-Term Mortality in Patients with heart Failure – Circulation
2004, 110, 17
5. Jonge P. – Only Incident Depressive Episodes After Myocardial Infarction Are Associated With New Cardiovascular Events
– JACC 2006;48:2204-8
6. Luukinen H. – Depressive symptoms and the risk of sudden cardiac death among the elderly – Eur. Heart J. 2003;
24:20210-2026
7. Jiang W. - Prognostic Value of Anxiety and Depression in Patients with Chronic Heart Failure – Circulation 2004;
110:3452-3456
8. Pfiffner A. – Psychosocial Predictors of death for Low-Risk Patients After a First Myocardial Infarction – J. Cariopulm.
Rehab. 2004;24:87-93
9. Rieckmann N. – Course of Depressive Symptoms and Medication Adherence After Acute Coronary Syndroms – JACC
2006;48:2215-7
10. van Melle J.P. – Beta-Blockers and Depression After Myocardial Infarction – JACC 2006;48:2209-14

151