Psychische Kosymptomatik von hausärztlichen Patienten mit Herzinsuffizienz

Abstract

Background and Purpose: Psychosocial distress is a common phenomenon in patients with heart failure (HF). The aim of this study was to analyze psychosocial co-symptoms and their relationship with clinical and sociodemographic factors. Methods: In 363 primary care patients with HF, anxiety, depression and negative affectivity (HADS, DS-14), disease coping (FKV) and social support (F-SozU) were measured by validated questionnaires. Severity of HF (according to NYHA classification and Goldman's Specific Activity Scale) and sociodemographic characteristics were documented by self-report instruments. Results: Increased anxiety and/or depression was found in 29.2% of patients. Anxiety and depression scores were significantly higher than in the German general population (P < 0.005). They were furthermore associated with NYHA and Goldman class (anxiety: p = 0.001; depression: p = 0.001). One third of the sample showed the type D personality pattern, which has been associated with increased mortality in cardiac patients. While HF severity correlated positively with psychological distress, patients living together with other persons had lower HF class than those living alone. Using regression analysis, sociodemographic and psychological variables predicted perceived severity of HF in 20.3% if measured by Goldman's scale (significant for sex, age, depressive symptoms and disease coping), and in 18.6% if measured by NYHA (significant for anxiety). Discussion: Severity of HF symptoms and psychosocial factors are interrelated. Self-reported severity of HF is substantially influenced by demographic and psychological variables. In this, it is not relevant if severity is measured by a nonvalidated (NYHA) or a validated instrument (Goldman). Conclusion: In primary care patients with HF, psychosocial co-symptoms are frequent and interfere with perceived severity of disease. Psychological distress should be considered important in diagnostics and treatment, especially in patients living alone.