Anxiety Associated with Increased Mortality Risk in CHD Patients - Especially with Comorbid Depression

Researchers at Duke University Medical Center and the University of North Carolina completed a cohort study of 934 individuals with confirmed coronary heart disease (CHD) to examine the role of anxiety and co-occurrence of depression and anxiety as association with mortality risk. (PDF - 884.85 KB) They found that anxiety and depression were common among CHD patients during hospitalizations for coronary angiography and each condition was associated with an approximate 2-fold increase in all-cause mortality. Additionally, the presence of anxiety and depression were additive, as those with anxiety and depression had a 3-fold increase in all-cause mortality. Researchers concluded that clinicians need to continually assess and monitor CHD patients for both anxiety and depression. The authors suggest that “future studies should focus on the co-occurrence of these psychosocial factors as markers of increased mortality risk.”

However, we would note the recommendations offered by the authors failed to recognize the link between assessment and treatment, and did not recognize the challenge of discontinuity of services. Just as the specialty cardiologists optimally confer and manage treatment plans with the family physician, these conversations and follow-up should take place with behavioral health professionals. Ideally, these patients would obtain primary care services in fully integrated clinics with ready access to behavioral health providers to address anxiety and depression needs, as well as the health behaviors that impact those with CHD. Future research and attention is needed to examine the integrated care that includes specialty medical providers for CHD patients (i.e. cardiologists) with family physicians, behavioral health experts, and other professionals to meet multifaceted patient needs.