Coexisting anxiety and depressive symptoms in patients with heart failure

Rebecca L. Dekker, Terry A. Lennie, Lynn V. Doering, Misook L. Chung, Jia Rong Wu, Debra K. Moser

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


Background: Among patients with heart failure (HF), anxiety symptoms may co-exist with depressive symptoms. However, the extent of overlap and risk factors for anxiety symptoms have not been thoroughly described. Purpose: The aim of this study was to describe the coexistence of anxiety and depressive symptoms, and to determine the predictors of anxiety symptoms in patients with HF. Methods: The sample consisted of 556 outpatients with HF (34% female, 6212 years, 54% New York Heart Association (NYHA) class III/IV) enrolled in a multicenter HF quality of life registry. Anxiety symptoms were assessed with the Brief Symptom Inventory-anxiety subscale. Depressive symptoms were measured with the Beck Depression Inventory- II (BDI). We used a cut-point of 0.35 to categorize patients as having anxiety symptoms or no anxiety symptoms. Logistic regression was used to determine whether age, gender, minority status, educational level, functional status, comorbidities, depressive symptoms, and antidepressant use were predictors of anxiety symptoms. Results: One-third of patients had both depressive and anxiety symptoms. There was a dose-response relationship between depressive symptoms and anxiety symptoms; higher levels of depressive symptoms were associated with a higher level of anxiety symptoms. Younger age (odds ratio (OR)= 0.97, p=0.004, 95% confidence interval (CI) 0.950.99) and depressive symptoms (OR =1.25, p0.001, 95% CI 1.191.31) were independent predictors of anxiety symptoms. Conclusions: Patients with HF and depressive symptoms are at high risk for experiencing anxiety symptoms. Clinicians should assess these patients for comorbid anxiety symptoms. Research is needed to test interventions for both depressive and anxiety symptoms.

Original languageEnglish
Pages (from-to)168-176
Number of pages9
JournalEuropean Journal of Cardiovascular Nursing
Issue number2
StatePublished - Apr 2014

Bibliographical note

Funding Information:
This research was supported by an American Association of Critical Care Nurses Phillips Medical Research award, the National Institutes of Health, National Institute of Nursing Research, K23 NR013480, R01 NR 008567, R01 NR 009280, the University of Kentucky General Clinical Research Center, M01RR02602, and the University of Kentucky College of Nursing Center for Biobehavioral Research on Self-Management, NINR, P20 NR 010679. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health.


  • Cardiovascular
  • anxiety disorder
  • depressive disorder
  • heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medical–Surgical
  • Advanced and Specialized Nursing


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