THE PREVALENCE AND SEVERITY OF DEPRESSION AND ANXIETY IN HEART FAILURE PATIENTS IN BULGARIA
Authors:   Department of propedeutics of internal diseases ", Kolev Vasil ,   Prof. Stoyan Kirkovich",   , Alexandrovska Hospital, Medical University, Sofia, Bulgaria., Manov Emil ,   Department of propedeutics of internal diseases "Prof. Stoyan Kirkovich", Alexandrovska Hospital, Medical University, Sofia, Bulgaria., Runev Nikolay ,   Department of propedeutics of internal diseases "Prof. Stoyan Kirkovich", Alexandrovska Hospital, Medical University, Sofia, Bulgaria., Stoimenov Blagovest ,   Department of propedeutics of internal diseases "Prof. Stoyan Kirkovich", Alexandrovska Hospital, Medical University, Sofia, Bulgaria., Onchev Georgi ,   Department of Psychiatry and Medical Psychology, Alexandrovska Hospital, Medical University, Sofia, Bulgaria., Pancheva Ralitsa ,   Department of propedeutics of internal diseases "Prof. Stoyan Kirkovich", Alexandrovska Hospital, Medical University, Sofia, Bulgaria.
Published: November 2023

Background: Depression and anxiety are common in patients with heart failure (HF). They are associated with adverse outcomes such as reduced adherence to treatment, poor ventricular function, increased hospitalizations, and higher mortality rate. However, despite the importance of these concomitant conditions, depression and anxiety often remain underdiagnosed and undertreated in patients with HF. Aim: The aim of the study is to evaluate the prevalence and severity of depression and anxiety in patients with HF. Materials and methods: 138 patients with chronic HF, a mean age of 70.29 ± 9.73 years and male/female ratio – 63 (45.7%)/75 (54.3%) were included in this cross-sectional study. Tests for depression (Hamilton Depression Rating Scale; HAM-D) and anxiety (Hamilton Anxiety Scale; HAM-A) were performed in all participants. Results: 114 (82.6%) of the patients with HF have depression and 98 (71%) – anxiety disorder. Mild depression was found in 38 (33.3%) patients and moderate – in 49 (42.9%). Severe depression was found in 21 (18.4%) of the patients and very severe – in 6 (5.3%). In our cohort, women more often were diagnosed with depression than men (71.4% vs. 28.6%, (p<0.05)). Older age above 70 years was associated with an incidence of depression (AUC 0.75, 67% sensitivity and 64% specificity, p<0.05). Significant predictors of depression in HF patients were anemia (OR 2.74 (95% CI 1.23-4.56, p<0.05), CKD (OR 12.29 (95% CI 1.57-16.17, P<0.05), ejection fraction below 50% (OR 4.35 (95% CI 2.07-8.85, P<0.05) and alcohol consumption (OR 6.39 (95% CI 1.72 – 15.14, P<0.05). Mild anxiety was diagnosed in 28 (28.6%) of the patients, 52 (53.1%) were with moderate and 18 (18.4%) – with severe anxiety. Predictors of anxiety in our HF cohort were poor controlled arterial hypertension (OR 2,18 (95% CI 1.26-5.57 P<0.05), alcohol consumption (OR 2,75, (95% CI 1.43-4.23, P<0.05), advanced HF (OR 4.57, (95% CI 2.02-7.66, P<0.05) and previous myocardial infarction (OR 3,25, (95% CI 1.89-5.53, P<0.05). Conclusions: Out data shows that the key factors associated with the risk of developing depression in patients with HF are: CKD, anemia, alcohol use, ejection fraction < 50, while the most important factors associated with the development of anxiety are: uncontrolled hypertension, alcohol use, advanced HF and previous MI.