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Cited by 65Cardiac Health and Mental HealthHeart Failure Treatment and ManagementMedication Adherence and Compliance

Linkages between anxiety and outcomes in heart failure

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De Jong, Marla J., Chung, Misook L., Wu, Jia-Rong, Riegel, Barbara, Rayens, Mary Kay, Moser, Debra K.·2011·Heart & Lung
DOI 10.1016/j.hrtlng.2011.02.002PMC PMC3149715
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Abstract

Objective We investigated the relationship between anxiety and event-free survival (ie, composite endpoint of death, emergency department visits, or hospitalizations) for patients with heart failure (HF), and examined whether behavioral and physiologic mechanisms mediate any association between anxiety and outcomes. Methods In this longitudinal study, patients with HF completed the anxiety subscale of the Brief Symptom Inventory, and heart-rate variability and plasma norepinephrine levels were measured. Dietary adherence and medication adherence were measured according to 24-hour urine sodium level and the Medication Event Monitoring System, respectively. Patients were followed at least 1 year for event-free survival. Results In total, 147 patients were enrolled. Patients with high anxiety had a shorter (hazard ratio, 2.2; 95% confidence interval, 1.1-4.3; P = .03) period of event-free survival than patients with lower anxiety. Anxiety independently predicted adherence to medication (P = .008), which in turn predicted event-free survival (hazard ratio, 2.0; 95% confidence interval, 1.2-3.3; P = .008). The effect of anxiety (P = .17) on event-free survival was less significant when the regression model included both anxiety and adherence to medication than when the model only included anxiety (P = .03), indicating that adherence to medication mediated the relationship between anxiety and event-free survival. Conclusion This is the first study to show that nonadherence to medication links anxiety and event-free survival for patients with HF. Interventions that reduce anxiety and improve adherence may benefit outcomes.

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Authors
De Jong, M. J., Chung, M. L., Wu, J.-R., Riegel, B., Rayens, M. K., & Moser, D. K.
Affiliations
  • University of Kentucky (US)
  • University of Pennsylvania (US)
ORCID
Venue
Heart & Lung
Publisher
Elsevier BV
Published
2011-09
Volume
40
Issue
5
Pages
393-404
ISSN
0147-9563 (ISSN-L)
DOI
10.1016/j.hrtlng.2011.02.002
PMC
PMC3149715
OpenAlex
W2034093495
Cited by
65
References
76
Citations by year
2026: 1 · 2024: 1 · 2023: 3 · 2021: 8 · 2020: 7 · 2019: 6 · 2018: 3 · 2017: 2 · 2016: 7 · 2015: 4 · 2014: 11 · 2013: 6 · 2012: 6
FWCI
5.28
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Heart & Lung (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Lincoln (University of Nebraska) (submittedVersion)
  • ScholarlyCommons (University of Pennsylvania) (submittedVersion)
  • Research Bank (Australian Catholic University) (submittedVersion)
Funders
  • TriService Nursing Research Program, Uniformed Services University of the Health Sciences
  • National Institutes of Health/National Institute of Nursing Research
  • TriService Nursing Research Program (N05-001)
  • National Institute of Nursing Research, an American Association of Critical-Care Nurses Phillips Medical Research Award (1P20NR010679)
  • University of Kentucky General Clinical Research Center (M01RR02602)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Keywords
heart failure, anxiety, event-free survival, medication adherence, dietary adherence, heart rate variability, plasma norepinephrine, Brief Symptom Inventory, mediation, hospitalization, emergency department visits, mortality
MeSH terms
Anxiety, Female, Health Status Indicators, Heart Failure, Humans, Kentucky, Longitudinal Studies, Male, Middle Aged, Norepinephrine, Outpatients, Psychometrics, Quality of Life, Surveys and Questionnaires, Treatment Outcome, Risk Assessment, Medication Adherence

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