Our objective was to assess the prevalence of panic disorder, its influence on quality of life (QoL), and the presence of further anxiety and depressive comorbid disorders in outpatients with chronic heart failure (CHF).
In a cross-sectional study, anxiety and depressive disorders were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria in patients with CHF who were aged ≥18 years and had New York Heart Association (NYHA) Functional Classes I -IV, using the Patient Health Questionnaire. Health-related QoL was evaluated using the Short-Form 36 Health Survey (SF-36).
Results
Of the 258 participating patients, 24 (9.3%) fulfilled diagnostic criteria for panic disorder. Seven of these (29.2%) were diagnosed with comorbid anxiety disorders, 11 (47.3%) were diagnosed with comorbid depressive disorder, and 5 (20.8%) were diagnosed with other anxiety disorders and any depressive disorder. Female gender [odds ratio (OR)=3.1; 95% confidence interval (95% CI)=1.2 -7.8; P=.02] and a lower level of education (OR=0.3; 95% CI=0.1 -0.9; P=.04) were associated with the presence of panic disorder. In patients with panic disorder, QoL was significantly more restricted on all subscales of the SF-36 as compared to those without panic disorder, even when age, gender, and NYHA functional class were controlled for (P=.05 to <.01).
Conclusion
Approximately 1 of 10 patients with CHF suffers from panic disorder, many of whom also have additional anxiety or depressive comorbid disorders. Female gender and a low level of education are positively associated with the presence of panic disorder. QoL is severely limited by the presence of panic disorder. Diagnosis of mental disorders and treatment offers for affected patients should be available in patient care.
Keywords: Heart failure; Panic disorder; Prevalence; Psychiatric comorbidities; Quality of life
Thomas Müller-Tasch, Lutz Frankenstein, Nicole Holzapfel, Dieter Schellberg, Bernd Löwe, Manfred Nelles, Christian Zugck, Hugo Katus, Bernhard Rauch, Markus Haass, Jana Jünger, Andrew Remppis and Wolfgang Herzog
Department of Psychosomatic and General Internal Medicine, University of Heidelberg, Heidelberg, Germany
Department of Cardiology, Angiology, and Pneumology, University of Heidelberg, Heidelberg, Germany
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Hamburg-Eilbek (Schön Clinics), Hamburg, Germany
Heart Center Ludwigshafen, Ludwigshafen, Germany
Department of Cardiology, Theresien-Hospital Mannheim, Mannheim, Germany
Received 9 July 2007; revised 10 September 2007; accepted 11 September 2007. Available online 19 February 2008.