Psychological distress and mortality MS ID#: CIRCULATIONAHA/2009/871483.R4 Psychological distress and mortality in systolic heart failure

Background: Depression, anxiety, and Type D (‘distressed’) personality (tendency to experience negative emotions paired with social inhibition) have been associated with poor prognosis in coronary heart disease, but less is known about their role in chronic heart failure (CHF). Therefore, we investigated whether these indicators of psychological distress are associated with mortality in CHF. Method and Results: Consecutive CHF outpatients (N=641; 74.3% men; mean age 66.6±10.0 years) filled out a four-item questionnaire to assess mixed Symptoms of Anxiety and Depression (SAD4) and the 14-item Type D Scale (DS14). Endpoints were defined as all-cause and cardiac mortality. After a mean follow-up of 37.6±15.6 months, 123 deaths were recorded (76 due to a cardiac cause). Cumulative hazard functions for elev anxiety/depression symptoms differed marginally for all-cause (p=.06) but not cardiac (p=.43) mortality; Type D personality was neither associated with all-cause (p=.63) nor cardiac mortality (p=.87). In multivariable analyses, neither elevated anxiety/depression symptoms nor Type D personality were associated with all-cause mortality (Hazard ratio(HR)=1.18, 95% Confidence Interval (CI) [0.76-1.84], p=.45 and HR=1.09, 95%CI [0.67-1.77], p=.73, respectively) or cardiac mortality (HR=1.13, 95%CI [0.63-2.04], p=.65 and HR=1.16, 95%CI [0.62-2.18], p=.67). In secondary analyses, a 1-point increase in anxiety/depression (range 016) was associated with a 8% increase in risk of all-cause mortality (HR=1.08, 95%CI [1.011.15], p=.02). ated Conclusions: Neither elevated anxiety/depression symptoms nor Type D personality were associated with an increased risk of all-cause or cardiac mortality. Future studies with adequate power and a longer follow-up duration are needed to further elucidate the role of psychological distress in CHF. Word count: 250