Comorbidity of Depression and Anxiety Leads to A Poor Prognosis Following Angina Pectoris Patients: A Prospective Study

Background: Depression and anxiety are two common psychiatric problems in patients with cardiovascular disease (CVD) and are associated with poor cardiac prognosis. The comorbidity of depression and anxiety is considered to be a more severe psychological status than non-comorbid psychiatric disorders. However, little is known about the relationship between depression or anxiety and noncardiac readmission. We conducted a prospective study on the prognostic impact of depression, anxiety, and comorbidity in angina pectoris (AP) patients. Method : In this prospective study, 443 patients with AP were included in the analysis. Follow-up assessments were performed 1 year, and 2 years after patient discharges. Clinical outcomes of interest included readmission, major cardiovascular event (MACE), and composite events. Depression and anxiety symptom scores derived from the patient health questionnaire-9 (PHQ-9) and generalised anxiety disorder-7 (GAD-7) questionnaire were used to assess mood symptoms. Participants with symptom scores of ≥ 10 on both questionnaires formed the comorbidity group. Using multivariable Cox proportional hazards models to evaluate the impact of psychiatric symptoms on clinical outcomes. Results: Among all the AP patients, 271 (61.2%) had non-depression symptoms and 172 (38. 9%) were determined to have depression symptoms. As for anxiety symptoms, 316 (71.3%), and 127 (28.7%) patients had non-anxiety, and anxiety respectively. After controlling covariates, we found that patients who endured clinical depression (hazard ratio [HR] = 2.12, 95% confidence interval [CI] 1.04–4.31, p=0.038) and anxiety ([HR] 2. 65, 95% [CI] 1.12–6.30, p=0.027) had a high risk of noncardiac readmission. Compared to participants with no psychiatric symptoms, those with comorbidities of depression and anxiety presented a greater risk of MACEs ([HR] 2.38, 95% [CI] 1.11–5.10, p=0.025) and noncardiac readmission ([HR] 2.91, 95% [CI] 1.03–8.18, p=0.043) while the single-symptom group did not show any significances on all the events. Conclusion: Depression and anxiety had predictive value for noncardiac readmission among patients with AP. Furthermore, prognoses were found to be worse for patients with comorbidities of depression and anxiety than those with single psychiatric symptoms. Additional attention needs to be focused on the initial identification and long-term monitoring of psychiatric comorbidity.