What is the clinical evidence from this study?

Study design: Systematic Review. Population: Chronic heart failure. Intervention: Anxiety vs. No anxiety or lower anxiety. Primary outcome: Hospitalisations and mortality rates (p=<0.05).

February 25, 2016

Anxiety in chronic heart failure and the risk of increased hospitalisations and mortality: A systematic review

Q: What are the key findings of this study?

Anxiety was significantly associated with increased hospitalisations (p<0.05) in some studies of chronic heart failure patients, while no significant association with mortality was identified.

Key Result

Anxiety was significantly associated with increased hospitalisations (p<0.05) in some studies of chronic heart failure patients, while no significant association with mortality was identified.

Study Design

Type

Systematic Review

PICO

Population

Systematic review of 6 prospective cohort studies investigating the association between anxiety and hospitalisations or mortality in patients with chronic heart failure.

Exposure / Comparator

Anxiety vs No anxiety or lower anxiety

Primary Outcome

Hospitalisations and mortality rates, p=<0.05

Main Result

p-value: p=<0.05

Limitations

Variation in quality of the studies in regards to their methodology, analysis and reported measures/outcomes

Abstract

BACKGROUND: Anxiety is a serious affective mood disorder that affects many chronic heart failure patients. While there is ample evidence that depression increases hospitalisations and mortality in chronic heart failure patients, it is unclear whether this association also exists for anxiety. OBJECTIVES: The purpose of this study was to report on prospective cohort studies investigating anxiety in chronic heart failure patients and its association with hospitalisations and mortality rates. This systematic review aims to improve the current knowledge of anxiety as a potential prognostic predictor in chronic heart failure populations. METHODS: This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were identified by accessing electronic databases Embase, Medline, Cumulative Index to Nursing and Allied Health Literature and PsycINFO. Studies were included if they: employed a prospective cohort study design, included chronic heart failure participants with a confirmed clinical diagnosis plus anxiety confirmed by a validated anxiety assessment tool and/or clinical diagnosis and reported longitudinal hospitalisation rates and mortality data in chronic heart failure. RESULTS: Six studies were identified for inclusion. A study investigating hospitalisations and mortality rates found a significant (p<0.05) association solely between hospitalisation and anxiety. Of four studies reporting on hospitalisations alone, only two reported significant associations with anxiety. One study reported rates of mortality alone and identified no significant associations between mortality and anxiety. There was some variation in quality of the studies in regards to their methodology, analysis and reported measures/outcomes, which may have affected the results reported. CONCLUSIONS: It is possible that anxiety does predict hospitalisations in chronic heart failure populations, however further research is required to confirm this observation.

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