Anxiety and/or depression in heart failure across the ejection fraction spectrum: the SwedeHF registry.

introductionLimited data exist on characteristics and clinical outcomes associated with anxiety and/or depression in heart failure (HF) across the different ejection fraction (EF) categories, particularly when considering aspects of health-related quality of life (HRQoL). To assess characteristics and clinical outcomes associated with anxiety and/or depression in patients with preserved, mildly reduced, and reduced EF (HFpEF, HFmrEF, and HFrEF).

methodsPatients were included from the Swedish Heart Failure Registry in 2008-23. Anxiety and/or depression levels (none, moderate, or severe) were self-reported using the EuroQoL five-dimensional three-level questionnaire (EQ-5D-3L). Multivariable multinomial regression was used to analyse baseline characteristics independently associated with self-reported anxiety/depression, with and without HRQoL adjustment. Time-to-first HF hospitalization (HFH), all-cause hospitalization, all-cause and cardiovascular (CV) death were assessed using Cox proportional hazards models.

resultsAmong 57 251 patients, 58% reported no, 38% moderate, and 4% severe symptoms of anxiety/depression, with similar distributions across EF categories. Self-reported anxiety/depression were associated with reduced HRQoL components. Without HRQoL adjustment, significant associations included higher NYHA class, liver disease, smoking, female sex, younger age, and inpatient status. Self-reported anxiety/depression levels were associated with higher risks of all outcomes at 12 months. After HRQoL adjustments, self-reported anxiety/depression remained associated with HFH and all-cause hospitalization but not death.

conclusionSelf-reported anxiety/depression were common across all HF categories, significantly associated with HRQoL, and associated with increased risk of HFH, all-cause hospitalization and death, but their impact on mortality diminished after adjustment for HRQoL.