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Depression, Anxiety, and Quality of Life in Patients With Atrial Fibrillation^*

^* From the University Department of Medicine, City Hospital, Birmingham, UK.

Correspondence to: Gregory Y. H. Lip, MD, University Department of Medicine, City Hospital, Birmingham, B18 7QH UK; e-mail: g.y.h.lip{at}bham.ac.uk

Abstract

Objective: To examine the prevalence and persistence of depression and anxiety in patients with atrial fibrillation (AF), and their effect on future quality of life (QoL) status.

Methods: The Beck Depression Inventory and State-Trait Anxiety Inventory were completed by 101 patients with AF (62 men; mean age ± SD, 66.3 ± 11.0 years), who were compared to 97 patients with hypertension (as "disease control" subjects) in sinus rhythm (64 men; mean age, 68.0 ± 7.2 years) at baseline and at 6 months. QoL was ascertained at both time points using Dartmouth Care Cooperative Information Project charts.

Results: At baseline among AF patients, symptoms of depression, state anxiety, and trait anxiety prevailed in 38%, 28%, and 38%, respectively; analogous data for hypertensive patients were 30%, 23%, and 22%. AF patients displayed higher levels of trait anxiety (p < 0.05), with no significant differences in baseline depression, state anxiety, and QoL between patients with AF and disease control subjects. Symptoms of depression and anxiety (state and trait) persisted at 6 months in 36.8% and 33.3%, respectively. Symptoms of depression (p < 0.001) and anxiety (p < 0.001) at baseline, female gender (p = 0.01), ethnicity (p = 0.01), and employment status (p = 0.03) were significantly correlated with QoL at 6 months in the patients with AF. Multiple regression analysis revealed that baseline depression score provided the best independent prediction of 6-month QoL (R² = 0.20), although gender and employment status also entered the model.

Conclusion: Approximately one third of AF patients have elevated levels of depression and anxiety, which persist at 6 months. Symptoms of depression were the strongest independent predictor of future QoL in these patients.

Key Words: anxiety • atrial fibrillation • depression • hypertension • quality of life