Psychosocial burden of cardiac patients: a retrospective in-patient analysis

Cardiac patients face a higher risk of developing depression or anxiety, displaying a bidirectional risk-relationship. While previous studies have focused on specific cardiac subgroups, such as heart failure (HF) populations, our study investigates a broad cardiac population to explore cofactors most strongly correlating with depressive or anxious symptoms. A total of n = 511 patients (mean age 63.57 ± 15.86 years, 41.9% female, 58.1% male) with heterogenous admission diagnoses admitted to the “Siebeck” ward of the Centre of Internal Medicine at the University Hospital Heidelberg were retrospectively analyzed. Psychiatric symptoms were quantified using the Patient Health Questionnaire-9-item depression module (PHQ-9), the 7-item Generalized Anxiety Disorder scale (GAD-7) and the Short Form-36 (SF-36) to evaluate health-related quality of life (HRQoL). Regression analyses included the variables sex, age, HF (mild, moderate and severe), the presence of an implanted cardioverter defibrillator (ICD), former or current cardiac decompensation (CD), cardiomyopathy (CM), and diabetes mellitus (DM) as predictors. A p < 0.05 was considered statistically significant. Younger age (PHQ-9: β = -0.117, p = 0.012; GAD-7: β = -0.205, p < 0.001) and female sex (PHQ-9: β = 0.118, p = 0.01; GAD-7: β = 0.164, p < 0.001) were significantly associated with elevated PHQ-9 and GAD-7 scores. CD (β = 0.149, p = 0.001), an ICD (β = 0.15, p = 0.002), and comorbid DM (β = 0.095, p = 0.036) were significantly associated with higher depression scores, while an ICD additionally correlated with more anxiety (β = 0.112, p = 0.024). Lower physical HRQoL was present in patients with DM (β = -0.163, p = 0.001) and CD (β = -0.147, p = 0.004). Relatively low adjusted R² values in the regression models reflect that only a small proportion of the variance in PHQ-9 (R² = 0.094) and GAD-7 (R² = 0.079) can be explained. Although severe HF was associated with higher PHQ-9 scores, the multivariate regression analyses did not confirm a significant association. Depressive and anxious symptoms, as well as physical HRQoL, are more strongly linked to specific clinical characteristics than to HF severity itself. Instead, younger age, female sex, CD, an ICD, and comorbid DM showed stronger associations with significantly increased depressive symptoms and lower HRQoL, while those with an ICD additionally described higher levels of anxiety. These findings support targeted psychosocial screening in these high-risk cardiac subgroups.