Investigation Of Mental Disorders And Affecting Factors In Patients With Chronic Heart Failure

Background:The prevalence of comorbidity mental disorders like anxiety and depression is very high.The mental disorders not only affect the quality of life in the course deeply,but also become the common inducement of deterioration repeatedly,hospitalization and death in CHF patients.Aim:Meta-analysis was made in the prevalence of anxiety/depression in CHF patients at home and aboard to certify the current situation of this field.The GAD-7,PHQ-9,PHQ-15 Questionnaire,self-made generally demographic and clinical questionnaire were applied in hospitalized CHF patients to get the prevalence and identification rate by residents of anxiety,depression and somatization symptoms.We investigated the influence factors of anxiety,depression and somatization symptom in hospitalized CHF patients and made a 2-year follow-up on partial patients to investigate the effect of anxiety,depression on prognosis.Method:The first part of this study was meta-analysis of 115 studies and30820 CHF cases with anxiety or depression before May 31^st,2019 in Medline,Embase and Cochrane Library databases.It was made in the way subject term combined freely with chronic heart failure,cardiac failure,heart failure,depression,depressive disorder,anxiety,anxiety disorder,prevalence.We calculated the pooled prevalence and odds ratio of anxiety or depression.Liner regression analysis was made in 17studies containing comparison of prevalence of anxiety and depression to investigate the relation between prevalence of anxiety and depression.The second part of this study was to investigate 220 inpatient CHF during from May,2018 to September,2020 in Cardiology department,Xiangya Hospital.The patients were measured or recorded by the GAD-7,PHQ-9,PHQ-15 Questionnaire,self-made generally demographic and clinical questionnaire,medical records and medical advice,etc.Then the prevalence and identification rate of anxiety,depression and somatization symptom were observed in hospitalized CHF patients.Univariate correlation analysis and multivariate logistic regression analysis were observed on the correlated factors of hospitalized CHF patients co-existing anxiety,depression and somatization symptom.The follow-up was made in early 101 patients to investigate the frequency of rehospitalization,whether cardiac events occurred,mortality,cardiac mortality and whether took antidepressant or anorexic drugs.Result:1.Meta analysis showed that the prevalence of anxiety in patients with CHF ranged from 8.6%to 62.0%,and the pooled prevalence was32.3%[95%CI（25.3%,40.1%）,I²=98.1%];The prevalence of depression ranged from 6.7%to 100%,and the pooled prevalence was 36.5%[95%CI（33.3%,38.2%）,I²=96.4%].2.The results of meta-analysis showed that there were differences in the prevalence of anxiety or depression in CHF patients,which was related to the test scale.The prevalence of anxiety was significantly correlated with the prevalence of depression.The prevalence of anxiety/depression in female patients was higher than that in male patients,the prevalence of anxiety in outpatient patients was higher than that in inpatients,and the prevalence of depression in patients with NYHA class III-IV was higher than patients with NYHA class I-II.3.This clinical study shows that the prevalence of depression,anxiety and somatization in hospitalized patients with CHF is 53.6%,39.5%and 71.8%.Only 44.4%of hospitalized patients with CHF and moderate or above anxiety,depression and somatization symptoms are recognized by clinical doctors.The anxiety,depression and somatization symptoms of CHF patients with higher NT-pro BNP level are not easier to be found by residents.4.Depression in hospitalized patients with CHF was related to medical burden,hospitalization times within 5 years,anxiety and somatization symptoms;Anxiety of hospitalized patients with CHF was related to female,depression and family relationship;Somatization symptoms of hospitalized patients with CHF were related to anxiety,depression and the number of hospitalizations within 5 years.5.Most patients with CHF complicated with anxiety and depression failed to adhere to standardized anti anxiety and depression treatment.Depression is the main factors affecting cardiac related morbidity in CHF patients during two-year follow-up.Conclusion:1.The prevalence of depression and anxiety was high in CHF patients.The different prevalence of depression and anxiety was related to the different Questionnaire;The prevalence of anxiety and depression was affected by gender and cardiac function level.The prevalence of anxiety in outpatients with CHF was higher than that in inpatients..2.The prevalence of anxiety,depression and somatization symptoms in hospitalized patients with chronic heart failure was high.It is worth noting that 71.8%of patients had somatization symptoms.3.The number of hospitalizations,social support and the level of cardiac function were related to anxiety and depression in hospitalized patients with chronic heart failure;Gender,cardiac function level and hospitalization times were the influencing factors of moderate and above anxiety,depression or somatization symptoms in hospitalized patients with chronic heart failure.4.Hospitalized CHF patients comorbidity somatization symptom was significantly positively related to anxiety,depression and hospitalization frequency.5.Nearly half of the hospitalized patients with CHF with moderate and above anxiety,depression and somatization symptoms were not recognized by clinical doctors.The level of NT-pro BNP was an important factor affecting doctors’recognition.6.Most patients with CHF complicated with anxiety and depression failed to adhere to standardized anti anxiety and depression treatment.Depression is the main factors affecting cardiac related morbidity in CHF patients.