Anxiety and depression are associated with NYHA class and ejection fraction in acute heart failure patients
L Sahakyan, S Nahapetyan, M Davtyan, E Khachatryan, R Mayrapetyan, L U S Sahakyan, H SisakyanAbstract
Background
Mental health disorders are increasingly recognized as important modifiers of cardiovascular outcomes. In line with the 2025 ESC recommendations on mental health and cardiovascular disease, there is growing interest in understanding the prevalence and clinical correlates of anxiety and depression in patients hospitalized for acute heart failure (AHF). However, despite their adverse impact, these disorders often remain underdiagnosed and undertreated in this population.
Purpose
To assess the prevalence of clinically significant anxiety and depressive symptoms and their association with heart failure severity among patients hospitalized for AHF.
Methods
This cross-sectional study included 60 consecutive patients hospitalized for AHF (mean age 70.5 ± 10.9 years; 40% female). Heart failure severity was assessed using NYHA functional class and left ventricular ejection fraction (LVEF). Reduced LVEF (≤40%) was present in 85% of patients, and 73.3% were in NYHA class III–IV at admission. Anxiety and depression were evaluated using GAD-7 and PHQ-9 questionnaires, with clinically relevant symptoms defined as GAD-7 ≥10 and PHQ-9 ≥10. Associations between mental health outcomes and clinical variables were assessed using chi-square tests, trend analysis, and binary logistic regression.
Results
Clinically relevant anxiety and depression were observed in 35% and 30% of patients, respectively. Both disorders were significantly more prevalent in patients with advanced heart failure. Depression occurred exclusively in NYHA class III–IV patients, with each one-class increase in NYHA functional class associated with an almost four-fold higher odds of depression (OR 3.96, 95% CI 1.32–11.89; p = 0.014). Anxiety was present in 12.5% of NYHA class I–II patients compared with 43.2% of those in NYHA class III–IV (OR 5.32, 95% CI 1.08–26.28; p = 0.028). Additionally, worsening EF was associated with a stepwise increase in both anxiety and depression prevalence (p for trend = 0.012 and 0.016, respectively).
Conclusions
Anxiety and depression are common among patients hospitalized for AHF and are strongly associated with heart failure severity, as reflected by NYHA functional class and reduced LVEF. These findings highlight the importance of routine mental health assessment and targeted interventions in patients with advanced heart failure.For image description, please refer to the figure legend and surrounding text.