Linkages between Anxiety and Outcomes in Heart Failure

Heart failure (HF) has been called the most important public health problem facing cardiovascular clinicians and researchers because of its increasing incidence, prevalence, morbidity, and mortality. As in the civilian community, the incidence of HF and associated treatment costs is increasing within the military health care system. Treatment regimens designed to improve the physiologic status of patients with HF have not significantly improved outcomes. Anxiety has an adverse effect on outcomes for patients with cardiac disease; however, little is known about how anxiety contributes to cardiovascular outcomes for patients with HF. Before new strategies can be designed to combat the rising HF epidemic, researchers must identify the mechanisms linking anxiety with poor outcomes for patients with HF. Accordingly, the specific aims of the proposed study are to (1) investigate the relationship between anxiety and HF patient outcomes (i.e., combined end-point of HF rehospitalizations, HF Emergency Department visits, or cardiac mortality) and (2) determine whether sympathetic nervous system arousal and nonadherence to prescribed treatment regimen mediate any association between anxiety and poorer HF outcomes. We hypothesize that anxious HF patients will have higher 6-month rates of the combined end-point and shorter time to the combined end-point than nonanxious HF patients. In addition, we hypothesize that sympathetic nervous system arousal and poor adherence mediate the association between anxiety and poorer HF outcomes. To test these hypotheses, 110 patients will be enrolled in a sub-study of a current study of HF patients. At baseline, anxiety, sympathetic nervous system arousal, and self-reported adherence will be measured. Adherence to prescribed medications will be assessed for 2 months. Six months later, patient outcomes will be measured. Data will be analyzed using readmission-free survival analyses and a mediation model consisting of a series of logistic regressions. The proposed research will provide researchers and clinicians with vital information from which to design effective interventions to decrease the extremely high mortality and rehospitalization rates in HF.

Final report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2013101737.xhtml