Symptoms of depression and anxiety predict mortality in patients undergoing oral anticoagulation: Results from the
Matthias Michal1, Jürgen H Prochaska2, Karsten Keller2
1Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany.
Insights
Depression and anxiety symptoms, measured by the Patient Health Questionnaire (PHQ-4), predict mortality in patients on long-term oral anticoagulation (OAC). Early screening for these conditions is crucial for cardiovascular patient outcomes.
Area of Science:
- Cardiology
- Psychiatry
- Public Health
Background:
- Cardiovascular patients frequently experience depression and anxiety.
- These mental health conditions may impact mortality risk in patients undergoing long-term oral anticoagulation (OAC).
Purpose of the Study:
- To investigate if the 4-item Patient Health Questionnaire (PHQ-4) can predict all-cause mortality in outpatients receiving long-term OAC.
- To assess the independent prognostic value of depression and anxiety symptoms in this patient population.
Main Methods:
- A cohort of 1384 outpatients on long-term OAC with vitamin K antagonists was studied.
- Symptoms of depression and anxiety were assessed at baseline using the PHQ-4.
- All-cause mortality was tracked over a 24-month period.
Main Results:
- A total of 191 deaths (13.8%) occurred during follow-up.
- Each point increase in PHQ-4 score correlated with a 10% increased mortality risk, even after adjusting for multiple clinical factors.
- Depression symptoms (PHQ-2) showed a stronger association with mortality (22% increase) than anxiety symptoms (GAD-2, 11% increase).
Conclusions:
- Elevated depression and anxiety symptoms are independently linked to increased all-cause mortality in OAC outpatients.
- The PHQ-4 is a valuable tool for prognostic assessment in this group.
- Regular screening and development of psychosocial interventions for OAC patients are recommended.
Background/Objectives:
Depression and anxiety are highly prevalent in cardiovascular patients. Therefore, we examined whether the 4-item Patient Health Questionnaire (PHQ-4, measuring symptoms of depression and anxiety) predicts all-cause mortality in outpatients with long-term oral anticoagulation (OAC).
Methods:
The sample comprised n=1384 outpatients from a regular medical care setting receiving long-term OAC with vitamin K antagonists. At baseline, symptoms of anxiety and depression were assessed with the PHQ-4 and the past medical history was taken. The outcome was all-cause mortality in the 24 month observation period. The median follow-up time was 13.3 months.
Results:
N=191 patients from n=1384 died (death rate 13.8%). Each point increase in the PHQ-4 score was associated with a 10% increase in mortality (hazard ratio [HR] 1.10, 95% confidence interval [95% CI] 1.05-1.16) after adjustment for age, sex, high school graduation, partnership, smoking, obesity, frailty according to the Barthel Index, Charlson Comorbidity Index and CHA2DS2-VASc score. The depression component (PHQ-2) increased mortality by 22% and anxiety (GAD-2) by 11% respectively. Neither medical history of any mental disorder, nor intake of antidepressants, anxiolytics or hypnotics predicted excess mortality.
Conclusions:
Elevated symptoms of depression and, to a lesser degree, symptoms of anxiety are independently associated with all-cause mortality in OAC outpatients. The PHQ-4 questionnaire provides valuable prognostic information. These findings emphasize the need for implementing regular screening procedures and the development and evaluation of appropriate psychosocial treatment approaches for OAC patients.
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