Original articlesEffects of anxiety and depression on 5-year mortality in 5057 patients referred for exercise testing
Introduction
Depression has been identified as an independent predictor of mortality in patients recovering from an acute myocardial infarction 1, 2, 3. In contrast, results from other patient groups with cardiovascular disease such as chronic coronary artery disease (CAD) or arterial hypertension are more conflicting 4, 5. Even less is known about the effect of anxiety on survival. Although some investigators have reported increased event rates, including sudden cardiac death in different groups with phobic anxiety 6, 7, 8, other studies found no such relationship [9] or even inverse relationships [10] between anxiety and objective CAD endpoints. It is not clear whether the latter observation simply reflects a selection bias of some retrospective studies or, at least in part, a real protective effect of nonphobic anxiety.
The present study was undertaken to investigate the effects of anxiety and depression on mortality in a large cohort of patients referred for diagnostic exercise testing.
Section snippets
Method
Between January 1990 and December 1992, a total of 7079 patients were referred to the cardiology department of a German university hospital for routine exercise testing. Of these, 5057 (71.4%) completed a screening questionnaire before undergoing the exercise test. Most of the remaining patients were missed because of logistical problems. These were mainly due to the fact that the electrocardiogram (ECG) assistants who distributed the questionnaires as part of their routine work after
Results
After a mean follow-up period of 5.7±0.8 years, follow-up survival data could be obtained for 5017 patients (99.2% of the initially screened 5057 patients). Forty patients were lost to follow-up, either because they were foreigners who had never been registered in Germany or because they emigrated from Germany after the baseline assessment. During the follow-up period, 457 patients (9.1% of the 5017 patients with valid survival data) had died. Univariate analyses revealed a variety of
Discussion
Chronic negative emotions have been implicated in morbidity and mortality from coronary artery disease [13]. However, inconclusive results have recently led to the suggestion that different groups of heart patients might be affected in different ways and that different psychological disturbances might have distinguishable effects [14]. For example, in a large study of 4367 elderly hypertensives, Wassertheil-Smoller et al. [5] did not find an increased 4.5-year mortality in patients who were
References (24)
- et al.
Biobehavioral variables and mortality or cardiac arrest in the Cardiac Arrhythmia Pilot Study (CAPS)
Am J Cardiol
(1990) - et al.
Depression and long-term mortality risk in patients with coronary artery disease
Am J Cardiol
(1996) - et al.
Anxiety proneness in coronary heart disease
J Psychosom Res
(1979) International experiences with the Hospital Anxiety and Depression Scale—a review of validation data and clinical results
J Psychosom Res
(1997)- et al.
Affective disorders and survival after acute myocardial infarction. Results from the post-infarction late potential study
Eur Heart J
(1991) - et al.
Major depression before and after myocardial infarctionits nature and consequences
Psychosom Med
(1996) - et al.
Change in depression as a precursor of cardiovascular events. SHEP Cooperative Research Group (Systolic Hypertension in the Elderly)
Arch Intern Med
(1996) - et al.
Phobic anxiety and ischemic heart disease
BMJ
(1987) - et al.
Prospective study of phobic anxiety and risk of coronary heart disease in men
Circulation
(1994) - et al.
Is anxiety early after myocardial infarction associated with subsequent ischemic and arrhythmic events?
Psychosom Med
(1996)
Depression and the course of coronary artery disease
Am J Psychiatry
The hospital anxiety and depression scale
Acta Psychiatrica Scand
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