P5424Anxiety and all-cause mortality in patients with congestive heart failure and implanted cardiac devices

Abstract

Abstract Background Several studies suggest that psychological factors including anxiety are associated with negative outcomes and in particular higher mortality rates among congestive heart failure (CHF) patients. However, the impact of anxiety on mortality in patients with implanted cardiac devices has not been fully appreciated. Purpose To estimate the influence of anxiety on all-cause mortality in patients with CHF after implantation of cardiac electronic devices. Methods The study enrolled 268 patients (mean age 57.1±10.1 years, 218 men and 50 women) with CHF and implanted cardiac devices (170 patients with implanted cardiac devices for resynchronization therapy, 98 patients - with implantable cardioverter defibrillators). We measured symptoms of anxiety with the Spielberger State-Trait Anxiety Inventory (STAI) scale. Cox proportional hazards regression model was used to estimate hazard ratios (HR) with 95% confidence interval (95% CI) for impact of anxiety symptoms on all-cause mortality. HR was calculated after adjustment for the following confounders: age, gender, smoking status, hypertension, diabetes mellitus, body mass index, hypercholesterolemia, atrial fibrillation, left ventricular ejection fraction, number of hemodynamically significant lesions of the coronary arteries and the type of the implanted cardiac devices. Results According to State-A scale 119 (44.4%) patients had light symptoms of state anxiety (SA), 115 (42.9%) – mild SA symptoms and 34 (12.7%) – expressed SA symptoms. According to Trait-A scale 10 (3.7%) patients had light trait anxiety (TA) symptoms, 99 (40.0%) – mild TA symptoms and 159 (59.3%) – expressed TA symptoms. During prospective observation period, 46 (17.2%) patients died of all-causes. Multivariant analysis in patients with the expressed SA symptoms resulted in mortality HR which complied 5.26, 95% CI 1.99–13.90; patients with the expressed TA symptoms – 3.5, 95% CI 1.48–6.29. Conclusion SA and TA have significant and independent influence on all-cause mortality in patients with CHF after implantation of cardiac electronic devices.