https://doi.org/10.1007/s00392-025-02625-4
1Universitätsmedizin der Johannes Gutenberg-Universität Mainz Kardiologie II - Rhythmologie Mainz, Deutschland; 2Universitätsmedizin der Johannes Gutenberg-Universität Mainz Kardiologie 1, Zentrum für Kardiologie Mainz, Deutschland; 3Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland
Background:
Psychological conditions such as depression, anxiety, vital exhaustion, and chronic stress are known to negatively impact the onset, progression, and outcomes of cardiovascular diseases. Heart failure with preserved ejection fraction (HFpEF) has a multifaceted etiology, and its development has been linked to mental health impairments. However, the directionality of this relationship remains unclear. This study aimed to longitudinally investigate the association between depressive and anxiety symptoms and the development of HFpEF.
Methods:
The PREDCIT-HFpEF trial followed 202 patients with elevated cardiovascular risk but without heart failure (HF) for the development of HFpEF. HFpEF was diagnosed clinically following ESC guideline recommendations. Depressive and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS) at baseline and follow-up. Clinically significant thresholds for HADS total, depression, and anxiety scores were ≥14, ≥8, and ≥8 points, respectively. Receiver operating characteristic (ROC) analysis was performed to evaluate the association between HADS scores and HFpEF development.
Results:
Over a median follow-up of 5 years, 31 patients (15%) developed HFpEF. These patients were older (73±8 vs. 67±8 years, p=0.01) with no gender differences between groups (44% female). At baseline, mean HADS total, depression, and anxiety scores were 10.6±6.9, 4.8±3.2, and 5.3±3.6, respectively. Clinically significant HADS total, depression, and anxiety scores were observed in 32.2%, 21.8%, and 27.7% of patients, respectively. No significant differences in baseline HADS scores were found between patients who developed HFpEF and those who did not. ROC analysis revealed that neither HADS total, depression, nor anxiety scores significantly predicted HFpEF development.
At follow-up, patients who developed HFpEF showed similar HADS total (p=0.21) and anxiety scores (p=0.82) but significantly higher depression scores (5.1±3.5 vs. 3.5±3.3, p=0.01), with more patients exhibiting clinically significant depression (19% vs. 11%). HADS depression scores at follow-up correlated with worse NYHA class, reduced daily activity, lower quality of life (SF-12 physical and mental scales), higher age, lower blood pressure, and worse right ventricular function (p<0.05 for all).
Conclusion:
Patients at risk for HFpEF experience mental health impairments comparable to those observed in the general population. Baseline mental health scores were not indicative of future HFpEF development. However, the emergence of HFpEF was associated with an increased burden of depressive symptoms, which correlated with worsened heart failure symptoms, reduced functional capacity, and impaired cardiac function.