Depression, Anxiety, and the Decline of Physical Functioning over 6 Months in Patients with Heart Failure

Transcription

1 Depression, Anxiety, and the Decline of Physical Functioning over 6 Months in Patients with Heart Failure Biing-Jiun Shen, PhD, Stacy Eisenberg, Uta Maeda, Kristen Farrell, MS, Ernst Schwartz, MD, Frank Penedo, PhD, Eugene Bauerlein, MD, Stephen Mallon, MD University of Southern California & University of Miami

2 Heart Failure (HF) Heart muscles too weak to pump sufficient amount of blood to provide for the body s metabolic needs A diverse, costly, and deadly disorder End stage heart disease Heart transplant

3 Heart Failure Heart Failure The only heart disease that is on the rise Prevalence: 5.7 million in US in 2006 ~550,000 new cases each year A contributing cause of 287,000 deaths in US per year

4 Cardiovascular Disease by Mortality CVD breakdown by mortality rates Congenital Defects 0.5% Artery Disease 4% Rheumatic Heart Disease 0.4% Other 13% High Blood Pressure 6% Heart Failure 6% Coronary Heart Disease (CHD) 53% Stroke 17% Source: AHA,

5 Psychosocial Factors & HF Depression 1 in 5 presents clinically significant depressive symptoms (Rutledge et al, 2006) Predicts higher mortality and more frequent hospitalization (Friedmann et al., 2006; De Jong et al., 2004; Jiang et al., 2001; Sherwood et al., 2007) Anxiety Estimated prevalence 18-64% (Haworth et al, 2005; Friedmann et al., 2006) Predicts higher mortality and more frequent hospitalization (Friedmann et al., 2006; De Jong et al., 2004; Tsuchihashi-Makaya et al., 2009)

6 Social Support Lower mortality (Murberg et al., 2004) c.f. No relationship (Friedmann et al., 2006) Better functioning in daily living activities (Clarke et al., 2000) Improvement of QoL over one year (Bennett et al., 2001) 6

7 HF-Related Physical Health Functioning HF Many severe physical symptoms & limitations Few studies have examined psychosocial factors & HF-related physical functioning

8 Research Questions How common are depression and anxiety in HF patients? Does depression, anxiety, social support predict physical health functioning? Cross-sectional 6-month follow-up Do changes in depression and anxiety predict follow-up physical functioning?

9 METHOD

10 Participants HF Patients >= 18 yo Primary Dx of HF No other life-threatening illnesses No active psychotic symptoms or severe cognitive impairments Participants 238 at baseline, 164 at 6-mo FU 9 died, 15 transplants, 50 failed to respond Dropouts did not differ in demographic, psychosocial and PHF scores except being younger, less likely to be married

11 Measures Physical Health Functioning Minnesota Living with Heart Failure Questionnaire (MLWHFQ) Physical Functioning Subscale Physical difficulties due to HF Fatigue, SOB, climbing stairs, chores, yard work, sitting, lying down to rest, sleeping at night etc. Medical Chart Reviews Cardiac disease history, other medical comorbidities, medication Blood Sample CV risk factors, fasting glucose, lipids

12 Psychosocial Measures Depression: Modified Centers for Epidemiologic Studies Depression Scale (CES-D) - 7 somatic symptoms: fatigue, effort, bothered, appetite, sleep, talking less, concentration Anxiety: Hospital Anxiety and Depression Scale (HADS) Social Support: MOS Social Support Survey

13 Demographic Characteristics (N = 164) Gender Marital Status Age = 55.4 (10.4) yrs Wom en 34% Men % Not Partnered 44% Partnered 56% Education Ethnicity >= College 20% < HS 15% Other 5% White 26% Some College HS 34% Hispanic 44% Black 24%

14 Medical Characteristics Mean LVEF = 26% (13%) NYHA Class Time since HF diagnosis: 78 (SD=93) months Class 4 6% Class 1 14% Class 3 36% Class 2 44% 14

15 Participant Characteristics CV Risk Factors and Health Behaviors Weight (in kg) 87 ± 19 BMI (kg/m 2 ) ± 6.39 SBP (mmhg) 117 ± 21 DBP (mmhg) 74 ± 11 % Hypertension 68% % Dyslipidemia 49% % Diabetes 33% % Current smoking 6% % Current alcohol use 27%

16 MAIN FINDINGS

17 Prevalence of Depression & Anxiety Depression (CES-D) Moderate- Severe 24% No 51% Anxiety (HADS) Mild 25% Severe 19% No 55% Borderline 26%

18 Concurrent Associations Baseline Psychosocial Factors & Physical Health Functioning Baseline physical functioning Depression β =.401, p <.001 β =.245, p =.001 Anxiety β =.421, p <.001 β =.246, p =.002 Social support β = -.059, p =.321 β = -.040, p =.455 Analyses adjusted for age, gender, marital status, education, NYHA class, treatment for depression or anxiety, and use of ACE inhibitor

19 Prospective Relationships Psychosocial Factors & Physical Health Functioning at 6 Months 6-month Physical Functioning Depression β =.154, p =.016 Ns Anxiety β =.207, p =.001 β =.279, p=.035 Social support β = -.029, p =.614 Ns Analyses adjusted for age, gender, marital status, education, NYHA class, treatment for depression or anxiety, and use of ACE inhibitor

20 Correlations Depression Depression Dep change Anxiety Anxiety change Depression change -.431(**).000 Anxiety.746(**) -.226(**) Anxiety change -.223(**).502(**) -.466(**) ** Correlation is significant at the 0.01 level (2-tailed). 20

21 Change in Depression & 6-Mo Physical Functioning Psychological Factor 6-Month Physical Health Functioning Depression at baseline β =.288, p <.001 Change in depression over 6 mo β =.276, p <.001 Anxiety at baseline β =.318, p <.001 Change in anxiety over 6 mo β =.230, p <.001 Social support at baseline β = -.031, p =.635 Change in social support over 6 months β = -.005, p =.860 Models adjusted for age, gender, marital status, education, NYHA class, treatment for depression or anxiety, and baseline physical functioning

22 Change in Anxiety & 6-Mo Physical Functioning Psychological Factor 6-Month Physical Health Functioning Depression at baseline β =.288, p <.001 Change in depression over 6 mo β =.276, p <.001 Anxiety at baseline β =.318, p <.001 Change in anxiety over 6 mo β =.230, p <.001 Social support at baseline β = -.031, p =.635 Change in social support over 6 months β = -.005, p =.860 Models adjusted for age, gender, marital status, education, NYHA class, treatment for depression or anxiety, and baseline physical functioning

23 Change in Social Support & 6-Mo Physical Functioning Psychological Factor 6-Month Physical Health Functioning Depression at baseline β =.288, p <.001 Change in depression over 6 mo β =.276, p <.001 Anxiety at baseline β =.318, p <.001 Change in anxiety over 6 mo β =.230, p <.001 Social support at baseline β = -.031, p =.635 Change in social support over 6 months β = -.005, p =.860 Models adjusted for age, gender, marital status, education, NYHA class, treatment for depression or anxiety, and baseline physical functioning

24 Summary Depression and anxiety symptoms are prevalent and fairly severe in HF patients Depression and anxiety decline of physical health functioning Increases in depression and anxiety further declines Social support? Assessing and treating emotional distress in HF patients may facilitate better management of their illness

25 Acknowledgement Tiffany Ju Annia Rodriguez Karen Irani Eliana Reyes Armando Mendez, PhD