Anxiety/diagnosis – ABC CARDIOL

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Editorial

Quality of Life in Heart Failure: An Important Goal in Treatment

Brenno Rizerio Gomes et al. Edimar Alcides Bocchi

Brazil is the country with the highest prevalence of anxiety disorders, according to the World Health Organization and ranks 5^th regarding the prevalence of depression. Mood disorders, which include anxiety and depression, are often neglected in clinical practice,^, and their diagnosis in patients with heart failure (HF) is even more challenging, given the overlap of several symptoms, such as fatigue, weight loss and sleep disorders.^,

In this issue of the Archives, the cross-sectional study by Figueiredo et al. evaluated, in a population of 99 patients with HF and reduced ejection fraction, which clinical, sociodemographic and psychological variables most correlated with the quality of life assessed by the Minnesota Living with Heart Failure Questionnaire. The main factors associated with poorer quality of life were dyspnea advanced functional class (New York Heart Association III and IV), previous hospitalization and anxiety symptoms. Depression was not independently associated with reduced quality of life, but several other studies have found this association.^, The study also shows an alarming prevalence of anxiety symptoms in these patients, of 50%, when compared to 9.3% in the overall population.

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Original Article

Synergistic Effect of Disease Severity, Anxiety Symptoms and Elderly Age on the Quality of Life of Outpatients with Heart Failure

José Henrique Cunha Figueiredo et al. Gláucia Maria Moraes de Oliveira Basílio Bragança Pereira Ana Elisa Bastos Figueiredo … Emília Matos Nascimento Marcelo Iorio Garcia Sergio Salles Xavier

Abstract

Background:

Heart failure (HF) is a multifactorial syndrome with repercussions on quality of life (QoL).

Objectives:

To investigate the main interacting factors responsible to worsen quality of life of outpatients with HF.

Methods:

Cross-sectional observational study with 99 patients of both genders, attending a HF outpatient clinic at a university hospital, all with a reduced ejection fraction (<40%) by echocardiography. They were evaluated using sociodemographic and clinical questionnaires, the Minnesota Living with Heart Failure (MLwHF), and the Hospital Anxiety and Depression scale (HADS). QoL was the outcome variable. Two multivariate models were used: the parametric beta regression analysis, and the non-parametric regression tree, considering p < 0.05 and 0.05 < p < 0.10 for statistical and clinical significance, respectively.

Results:

Beta regression showed that depression and anxiety symptoms worsened the QoL of HF patients, as well as male sex, age younger than 60 years old, lower education level, lower monthly family income, recurrent hospitalizations and comorbidities such as ischemic heart diseases and arterial hypertension. The regression tree confirmed that NYHA functional class III and IV worsen all dimensions of MLwHF by interacting with anxiety symptoms, which influenced directly or indirectly the presence of poorer total score and emotional dimension of MLwHF. Previous hospitalization in the emotional dimension and age younger than 60 years in general dimension were associated with anxiety and NYHA functional class, also worsening the QoL of HF patients.

Conclusion:

HF with reduced ejection fraction was associated with poorer MLwHF. Anxiety symptoms, previous hospitalization and younger age were also associated with worsened MLwHF. Knowledge of these risk factors can therefore guide assessment and treatment of HF patients.