Study Suggests Anxiety Disorders and Depression Associated with Risk of Future Heart Failure among Veterans
Depression is prevalent in patients with established heart failure (HF), and it contributes to increased healthcare utilization, greater likelihood of hospitalization, poor health status, increased rates of clinical events, and mortality. Commonly comorbid with depression, anxiety disorders also are associated with adverse outcomes in patients with established HF. This retrospective cohort study sought to determine if the risk of HF was greater in Veterans with: 1) a diagnosis of one or more anxiety disorders but who were free of major depressive disorder (MDD) (n=22,457); 2) MDD but free of anxiety disorders (n=24,721); or 3) comorbid anxiety and depressive disorders (n=29,419). Using VA data, investigators identified 236,079 Veterans (ages 50-80) who were regular users of VA healthcare and were free of cardiovascular disease at baseline. Using VA inpatient and outpatient records, investigators assessed the rates of incident HF from 10/1/00 to 9/30/07. Covariates that were examined included sociodemographics, having only VA healthcare benefits vs. co-insurance (access to non-VA care), and risk factors associated with cardiovascular disease (e.g., hypertension, diabetes, and obesity). Investigators also examined smoking history, illicit drug abuse, alcohol dependence, and the use of psychotropic medications.
- In the model that corrected for age only, Veterans with anxiety disorders, MDD, or both were each about 20% more likely to develop HF compared to Veterans without these conditions. This effect remained significant after adjusting for other HF risk factors (e.g., sociodemographics, nicotine use, substance use disorders), and was even greater after adjusting for psychotropic medications.
- Compared to Veterans without HF, patients with HF were significantly older and more frequently male, non-white, unmarried, holders of supplemental insurance, and were significantly more likely to have diagnoses of hypertension, diabetes, and obesity.
- Veterans with both anxiety and MDD were more likely to have a diagnosis of substance abuse or dependence and history of nicotine use – and to receive a prescription for psychotropic medication.
- Administrative data have inherent limitations compared to prospective clinical assessments.
- Despite routine screening in VA, it is possible that undiagnosed cases of depression and/or anxiety were misclassified, leading to bias of the estimate.
- The authors suggest that prospective studies are needed to clarify the role of depression and anxiety – and their pharmacological treatment, in the etiology of heart failure.
Dr. Scherrer was supported by an HSR&D Career Development Award. Drs. Scherrer and Hauptman are part of the VA Medical Center in St. Louis, MO.
Garfield L, Scherrer J, Hauptman P, et al. Association of Anxiety Disorders and Depression with Incident Heart Failure. Psychosomatic Medicine February 2014;76(2):128-36.