Effect of somatic symptoms, anxiety and depression on clinical prognosis in patients with chronic heart failure

doi:10.3969/j.issn.1674-8115.2023.09.009

Abstract

Abstract:

Objective ·To explore the association of somatizatic symptoms, anxiety and depression with clinical prognosis in the patients with chronic heart failure (CHF). Methods ·The patients with CHF who visited the Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021 were included. Demographic data and clinical features of the patients were collected. The Self-reported Somatic Symptom Scale of China (SSS-CN), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) were used to evaluate the patients′ conditions. Telephone follow-up was conducted at the 12th month after the first visit, and the specific information of the patients′ end-point events (including death, re-hospitalization, causes of death and re-hospitalization) was collected. Survival curve and Cox regression analysis were used to evaluate the clinical prognosis of the patients. Results ·A total of 195 patients were included. The SSS-CN scores in CHF patients were different between the two genders, among the different heart rate groups and the different cardiac function grades of New York Heart Association (NYHA), also between the patients with anxiety/depression or not (all P<0.05). Survival curve analysis showed that overall survival rate of patients in the moderate-severe somatic symptoms group was lower than that of the patients in the normal-mild group (Log rank P=0.020). Cox regression analysis showed that compared with the normal-mild group, the patients in the moderate-severe somatic symptoms group had a higher risk of all-cause death [hazard ratio (HR)=2.797, 95%CI 1.135－6.890]; the CHF patients with depressive symptoms had a higher risk of all-cause death (HR=2.883, 95%CI 1.150－6.984). Compared with the normal-mild group, the patients with moderate-severe somatic symptoms had a higher risk of cardiovascular death (HR=2.784, 95%CI 1.073－7.226). The CHF patients with depressive symptoms had a higher risk of cardiovascular death (HR=2.823, 95%CI 1.087－7.330). There were no statistically differences in anxiety, depression, somatization symptoms and their severity between all-cause hospitalization and hospitalization due to CHF. Conclusion ·The moderate-severe somatic symptoms and depression are the risk factors of all-cause death and cardiovascular death in the patients with CHF.

Key words: chronic heart failure, somatic symptom, depression, anxiety

CLC Number:

R546.1⁺1

LU Qifan, LIU Qiming, ZHOU Hongmei, CHAI Yezi, JIANG Meng, PU Jun. Effect of somatic symptoms, anxiety and depression on clinical prognosis in patients with chronic heart failure[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(9): 1153-1161.

Figures/Tables 5

TrendMD

References 28

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Item	Participant/n(%)	SSS-CN
Item	Participant/n(%)	Score/point	P value
Gender			0.017
Male	132 (67.69)	32.0 (27.0, 39.0)
Female	63 (32.31)	34.0 (30.0, 42.0)
Age			0.141
<60 years	88 (45.13)	31.0 (26.0, 39.0)
≥60 years	107 (54.87)	34.0 (28.8, 41.1)
Marriage status			0.992
Married	189 (96.92)	32.5 (28.5, 46.0)
Not married	4 (2.05)	33.0 (28.5, 40.0)
Divorced	2 (1.03)	36.5 (33.0, 37.5)
Job			0.401
Retired or unemployment	121 (62.05)	34.0 (29.0, 41.0)
In service	74 (37.95)	32.5 (27.5, 38.5)
Education			0.881
Middle school and below	68 (34.87)	33.5 (28.4, 40.1)
High school	63 (32.31)	33.5 (29.0, 40.2)
College	59 (30.26)	29.5 (25.6, 36.2)
Master and above	5 (2.56)	33.0 (28.0, 40.0)
PHQ-9			0.000
>4 points	51 (26.15)	41.0 (36.0, 49.0)
≤4 points	144 (83.75)	30.0 (26.0, 36.0)
GAD-7			0.000
>4 points	34 (17.43)	41.0 (37.9, 41.5)
≤4 points	161 (82.57)	31.0 (27.0, 37.0)
NYHA classification			0.013
Ⅰ－Ⅱ	144 (73.85)	30.0 (26.0, 37.0)
Ⅲ－Ⅳ	51 (26.15)	37.0 (30.5, 45.5)
Heart rate			0.016
<68 bpm	51 (26.15)	36.0 (30.0, 45.3)
≥68 and <75 bpm	42 (21.54)	28.0 (26.0, 32.8)
≥75 and <81 bpm	53 (27.18)	31.0 (27.0, 37.0)
≥81 bpm	49 (25.13)	33.0 (29.0, 42.0)
Blood pressure			0.710
SBP>140 mmHg or DBP>90 mmHg	44 (22.56)	32.5 (28.0, 40.0)
SBP≤140 mmHg and DBP≤90 mmHg	151 (77.44)	33.0 (28.2, 40.8)
BMI			0.902
≥25 kg·m^-2	57 (29.23)	31.5 (27.2, 38.8)
<25 kg·m^-2	138 (70.77)	32.0 (27.0, 41.0)
LVEF			0.674
≤40%	84 (43.08)	31.0 (28.0, 38.0)
40%<LVEF<50%	52 (26.67)	33.0 (29.0, 41.8)
≥50%	59 (30.25)	34.0 (26.0, 40.0)

Item	Participant/n(%)	SSS-CN
Item	Participant/n(%)	Score/point	P value
Gender			0.017
Male	132 (67.69)	32.0 (27.0, 39.0)
Female	63 (32.31)	34.0 (30.0, 42.0)
Age			0.141
<60 years	88 (45.13)	31.0 (26.0, 39.0)
≥60 years	107 (54.87)	34.0 (28.8, 41.1)
Marriage status			0.992
Married	189 (96.92)	32.5 (28.5, 46.0)
Not married	4 (2.05)	33.0 (28.5, 40.0)
Divorced	2 (1.03)	36.5 (33.0, 37.5)
Job			0.401
Retired or unemployment	121 (62.05)	34.0 (29.0, 41.0)
In service	74 (37.95)	32.5 (27.5, 38.5)
Education			0.881
Middle school and below	68 (34.87)	33.5 (28.4, 40.1)
High school	63 (32.31)	33.5 (29.0, 40.2)
College	59 (30.26)	29.5 (25.6, 36.2)
Master and above	5 (2.56)	33.0 (28.0, 40.0)
PHQ-9			0.000
>4 points	51 (26.15)	41.0 (36.0, 49.0)
≤4 points	144 (83.75)	30.0 (26.0, 36.0)
GAD-7			0.000
>4 points	34 (17.43)	41.0 (37.9, 41.5)
≤4 points	161 (82.57)	31.0 (27.0, 37.0)
NYHA classification			0.013
Ⅰ－Ⅱ	144 (73.85)	30.0 (26.0, 37.0)
Ⅲ－Ⅳ	51 (26.15)	37.0 (30.5, 45.5)
Heart rate			0.016
<68 bpm	51 (26.15)	36.0 (30.0, 45.3)
≥68 and <75 bpm	42 (21.54)	28.0 (26.0, 32.8)
≥75 and <81 bpm	53 (27.18)	31.0 (27.0, 37.0)
≥81 bpm	49 (25.13)	33.0 (29.0, 42.0)
Blood pressure			0.710
SBP>140 mmHg or DBP>90 mmHg	44 (22.56)	32.5 (28.0, 40.0)
SBP≤140 mmHg and DBP≤90 mmHg	151 (77.44)	33.0 (28.2, 40.8)
BMI			0.902
≥25 kg·m^-2	57 (29.23)	31.5 (27.2, 38.8)
<25 kg·m^-2	138 (70.77)	32.0 (27.0, 41.0)
LVEF			0.674
≤40%	84 (43.08)	31.0 (28.0, 38.0)
40%<LVEF<50%	52 (26.67)	33.0 (29.0, 41.8)
≥50%	59 (30.25)	34.0 (26.0, 40.0)

Item	All-cause hospitalization			Heart failure induced hospitalization
Item	None (n=174)	Yes (n=21)	P value	None (n=187)	Yes (n=8)	P value
Gender/n(%)			0.915			0.139
Female	56 (32.18)	7 (33.33)		58 (31.02)	5 (62.50)
Male	118 (67.82)	14 (66.67)		129 (68.98)	3 (37.50)
Age/year	57.0±14.4	65.8±14.6	0.000	57.5±14.4	68.1±16.5	0.043
SSS-CN/n(%)			0.589			0.874
≤29 points	60 (34.48)	6 (28.57)		64 (34.22)	2 (25.00)
>29 points	114 (65.52)	15 (71.43)		123 (65.78)	6 (75.00)
SSS-CN/n(%)			0.428			0.738
≤39 points	130 (74.71)	14 (66.67)		139 (74.33)	5 (62.50)
>39 points	44 (25.29)	7 (33.33)		48 (25.67)	3 (37.50)
PHQ-9/n(%)			0.240			0.247
>4 points	131 (75.29)	13 (61.90)		140 (74.87)	4 (50.00)
≤4 points	43 (24.71)	8 (38.10)		47 (25.13)	4 (50.00)
GAD-7/n(%)			0.965			0.957
>4 points	139 (79.89)	18 (85.71)		150 (80.21)	7 (87.50)
≤4 points	35 (20.11)	3 (14.29)		37 (19.79)	1 (12.50)
NYHA classification/n(%)			0.037			0.039
Ⅰ－Ⅱ	133 (76.4)	11 (52.63)		141 (75.41)	3 (37.50)
Ⅲ－Ⅳ	41 (23.5)	10 (47.37)		46 (24.59)	5 (62.50)
Heart rate/bpm	76.1±12.0	76.4±12.4	0.562	76.4±12.1	72.4±10.2	0.365
SBP/mmHg	127.06±19.11	127.39±19.81	0.606	127.23±19.47	124.25±12.19	0.670
DBP/mmHg	79.38±13.23	80.18±13.17	0.073	79.89±13.13	71.00±12.80	0.065
Height/cm	168.62±8.09	168.19±8.42	0.843	168.63±7.97	167.57±10.61	0.740
Weight/kg	72.38±16.61	66.31±11.35	0.163	72.17±16.21	61.71±9.88	0.096
BMI/(kg·m^-2)	25.36±4.99	23.31±2.63	0.112	25.28±4.83	21.86±1.80	0.066
TNI/(ng·mL^-1)	0.03 (0.01, 0.16)	0.01 (0.01, 0.03)	0.174	0.04 (0, 0.07)	0.04 (0, 0.07)	0.750
BNP/(pg·mL^-1)	214.0 (100.0, 573.5)	225.5 (49.0, 510.7)	0.736	205.0 (49.0, 491.0)	508.0 (241.0, 980.0)	0.467
LVEF/n(%)			0.531			0.195
≤40%	71 (40.80)	13 (61.90)		79 (42.25)	5 (62.50)
40%<LVEF<50%	47 (27.01)	5 (23.81)		50 (26.73)	2 (25.00)
≥50%	56 (32.19)	3 (14.29)		58 (31.02)	1 (12.50)

Item	All-cause hospitalization			Heart failure induced hospitalization
Item	None (n=174)	Yes (n=21)	P value	None (n=187)	Yes (n=8)	P value
Gender/n(%)			0.915			0.139
Female	56 (32.18)	7 (33.33)		58 (31.02)	5 (62.50)
Male	118 (67.82)	14 (66.67)		129 (68.98)	3 (37.50)
Age/year	57.0±14.4	65.8±14.6	0.000	57.5±14.4	68.1±16.5	0.043
SSS-CN/n(%)			0.589			0.874
≤29 points	60 (34.48)	6 (28.57)		64 (34.22)	2 (25.00)
>29 points	114 (65.52)	15 (71.43)		123 (65.78)	6 (75.00)
SSS-CN/n(%)			0.428			0.738
≤39 points	130 (74.71)	14 (66.67)		139 (74.33)	5 (62.50)
>39 points	44 (25.29)	7 (33.33)		48 (25.67)	3 (37.50)
PHQ-9/n(%)			0.240			0.247
>4 points	131 (75.29)	13 (61.90)		140 (74.87)	4 (50.00)
≤4 points	43 (24.71)	8 (38.10)		47 (25.13)	4 (50.00)
GAD-7/n(%)			0.965			0.957
>4 points	139 (79.89)	18 (85.71)		150 (80.21)	7 (87.50)
≤4 points	35 (20.11)	3 (14.29)		37 (19.79)	1 (12.50)
NYHA classification/n(%)			0.037			0.039
Ⅰ－Ⅱ	133 (76.4)	11 (52.63)		141 (75.41)	3 (37.50)
Ⅲ－Ⅳ	41 (23.5)	10 (47.37)		46 (24.59)	5 (62.50)
Heart rate/bpm	76.1±12.0	76.4±12.4	0.562	76.4±12.1	72.4±10.2	0.365
SBP/mmHg	127.06±19.11	127.39±19.81	0.606	127.23±19.47	124.25±12.19	0.670
DBP/mmHg	79.38±13.23	80.18±13.17	0.073	79.89±13.13	71.00±12.80	0.065
Height/cm	168.62±8.09	168.19±8.42	0.843	168.63±7.97	167.57±10.61	0.740
Weight/kg	72.38±16.61	66.31±11.35	0.163	72.17±16.21	61.71±9.88	0.096
BMI/(kg·m^-2)	25.36±4.99	23.31±2.63	0.112	25.28±4.83	21.86±1.80	0.066
TNI/(ng·mL^-1)	0.03 (0.01, 0.16)	0.01 (0.01, 0.03)	0.174	0.04 (0, 0.07)	0.04 (0, 0.07)	0.750
BNP/(pg·mL^-1)	214.0 (100.0, 573.5)	225.5 (49.0, 510.7)	0.736	205.0 (49.0, 491.0)	508.0 (241.0, 980.0)	0.467
LVEF/n(%)			0.531			0.195
≤40%	71 (40.80)	13 (61.90)		79 (42.25)	5 (62.50)
40%<LVEF<50%	47 (27.01)	5 (23.81)		50 (26.73)	2 (25.00)
≥50%	56 (32.19)	3 (14.29)		58 (31.02)	1 (12.50)

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