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An investigation into the nature, prevalence and severity of anxiety in heart failure patients: The association between anxiety and patient’ health outcomes

Easton, Katherine Anne

[Thesis]. Manchester, UK: The University of Manchester; 2013.

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Abstract

Long Term Conditions (LTCs) with co-morbid common mental health conditions of anxiety and depression present a significant challenge for UK health and social care services. Depression and anxiety are common in heart failure (HF) patient populations and research suggests depression has a detrimental effect on a range of health outcomes, including Health related Quality of Life (HRQoL). The impact of anxiety is relatively under-researched in this patient group. In this doctoral study a systematic review was conducted to consolidate the evidence base for the prevalence and variance of rates of anxiety in HF patients. Importantly, the relative contribution of anxiety symptoms, measured using the Hospital Anxiety and Depression Scale (HADS), to reported HRQoL , measured using the Kansas City Cardiomyopathy Questionnarie (KCCQ) was examined in a cross-sectional survey of 158 HF patients attending specialist HF outpatient clinics. The systematic review identified 72 studies, with reported rates of anxiety varying dramatically, ranging from 6.2% to 72.3%. The random effects pooled prevalence estimate for anxiety disorders was 13.01% (95% CI 9.3% - 16.9%), for probable clinically significant anxiety was 28.8% (95% CI 23.3% - 34.3%) and the random effects pooled prevalence estimate for elevated symptoms of anxiety was 55.5% (95% CI 48.1% - 62.8%). Not all tools used to assess anxiety were population appropriate. In the survey multivariate analysis found that anxiety symptoms, did not account for a significant proportion of unique variance in HRQoL scores. Higher levels of physical symptom burden, depression and an increased number of physical co-morbidities predominantly account for 69% of the variance in HRQoL (F13,125 = p <0.0005). The findings highlight the need for accurate and valid measurement of anxiety and depression within the context of a physical LTC. Anxiety and depression are common in HF patients and the evidence suggests depression in particular predicts reported HRQoL. Further research is required to understand more about the role of anxiety in influencing patient’s health outcomes.