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Depression, anxiety increase mortality risk in patients undergoing oral anticoagulation
Among outpatients receiving long-term oral anticoagulation, elevated symptoms of depression and anxiety are associated with all-cause mortality, according to research published in the International Journal of Cardiology.
Findings from a study that used a four-item Patient Health Questionnaire (PHQ-4) to assess depression and anxiety underscore the need to implement routine screening procedures and to develop and evaluate psychosocial treatment approaches, according to researchers.
“The results of the present study indicate that outpatients undergoing [oral anticoagulation] with vitamin K antagonists had a significantly higher risk for death if they were burdened with symptoms of depression or anxiety,” the researchers wrote.
Matthias Michal, MD, of the University Medical Center of the Johannes Gutenberg-University Mainz and the German Center for Cardiovascular Research, and colleagues examined whether the PHQ-4 would predict all-cause mortality in 1,384 outpatients.
The patients were part of the observational thrombEVAL study in the German federal state of Rhineland-Palatinate and receiving long-term oral anticoagulation with vitamin K antagonists.
At baseline, depression and anxiety symptoms were assessed with the PHQ-4, and the medical history obtained. The researchers looked for all-cause mortality during 24 months; the median follow-up period was 13.3 months.
The death rate was 13.8%, with 191 patients dying. Every PHQ-4 point increase was associated with a 10% increase in mortality (HR = 1.1; 95% CI, 1.05-1.16) after adjusting for age, sex, high school graduation, partnership, smoking, obesity, frailty (Barthel index, Charlson comorbidity index) and CHA2DS2-VASc score.
Mortality increased by 22% based on the depression component of the questionnaire and by 11% based on the anxiety component. Medical history of mental disorders did not predict excess mortality, nor did the intake of antidepressants, anxiolytics or hypnotics.
“These findings emphasize the need for structured screening procedures in order to identify the actual mental distress,” the researchers wrote. “Mere reliance on the previous diagnosis of a mental disorder will underestimate the actual burden and corresponding treatment needs.” – by Allegra Tiver
Disclosure: The researchers report no relevant financial disclosures.