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Comparing the effects of depression, anxiety and comorbidity on quality-of-life, adverse outcomes and medical expenditure in Chinese patients with acute coronary syndrome.

BACKGROUND: Depression and anxiety have been correlated with elevated risks for quality-of-life (QOL), adverse outcomes and medical expenditure in patients with acute coronary syndrome (ACS). However, the relevant data are lacking for Chinese ACS populations, especially regarding different effects of major depression, anxiety and comorbidity. The objective of this study was to evaluate the dynamic changes of depression and/or anxiety over 12 months and examine the effects of depression, anxiety and comorbidity on QOL, adverse outcomes and medical expenditure in Chinese ACS patients.

METHODS: For this prospective longitudinal study, a total of 647 ACS patients were recruited from North China between January 2013 and June 2015. Among them, 531 patients (82.1%) completed 12-month follow-ups. Logistic regression model was utilized for analyzing the association of baseline major depression, anxiety and comorbidity with 12-month all-cause mortality, cardiovascular events, QOL and health expenditure.

RESULTS: During a follow-up period of 12 months, 7.3% experienced non-fatal myocardial infarction (MI) and 35.8% cardiac rehospitalization. Baseline comorbidity, rather than major depression/anxiety, strongly predicted poor 12-month QOL as measured by SF-12 (OR: 1.77, 95%CI: 1.22-2.52, p = 0.003). Regarding 12-month non-fatal MI and cardiac rehospitalization, baseline anxiety (OR: 2.83, 95%CI: 1.33-5.89, p < 0.01; OR: 4.47, 95%CI: 1.50-13.00, p < 0.01), major depression (OR: 2.58, 95% CI: 1.02-6.15, p < 0.05; OR: 5.22, 95%CI: 1.42-17.57, p < 0.03) and comorbidity (OR: 6.33, 95%CI: 2.96-13.79, p < 0.0001, OR: 14.08, 95%CI: 4.99-41.66, p < 0.0001) were all independent predictors. And comorbidity had the highest predictive value. Number of rehospitalization stay, admission frequency within 12 months and medical expenditure within 2 months were the highest in ACS patients with comorbidity.

CONCLUSIONS: Major depression and anxiety may predict 12-month non-fatal MI and cardiac rehospitalization. However comorbidity has the highest predictive value with greater medical expenditure and worse QOL in Chinese ACS patients. And depression with comorbid anxiety may be a new target of mood status in ACS patients.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. https://creativecommons.org/licenses/by-nc-nd/4.0.

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