The KOORDINATA study (clinical epidemiological program of investigation of depression in cardiological practice in patients with arterial hypertension and ischemic heart disease) was a prospective 3 year long multicenter study of effects of depressive and anxiety states on the course and prognosis of ischemic heart disease (IHD) and arterial hypertension (AH).
Patients (n=5038, age more or equal 55 years) with verified IHD and/or AH from 37 cities were included into the study. Symptoms of anxiety and depression were assessed by the HADS scale (Hospital Anxiety And Depression Scale) validated in Russia.
Clinically significant symptoms of anxiety ( more or equal 11 HADS) were present in 33 and 38%, of depression - in 30 and 38% of patients with IHD and AH, respectively. Presence of clinically manifested depression at initial examination increased 1.59 times combined risk of nonfatal and fatal cases (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.30-1.96, p=0.0001), 1.64 times - risk of cardiovascular death (OR 1.64, 95% CI 1.20-2.24, p=0.0021), and 1.82 times - risk of death from all causes (OR 1.82, 95% CI 1.41-2.34, p=0.0001). It is known that for somatic patients crossover of anxiety and depression symptoms is typical (simultaneous presence of some symptoms of anxiety and depression). Total HADS score equal to 11 or more increased risk of all cause death (OR 1.41, 95% CI 1.08-1.84, p=0.0111), as well as fatal and nonfatal events (OR 1.33, 95% CI 1.08-1.65, p=0.0089).
Taking into consideration negative effect of depressive symptoms on prognosis it is recommended to screen patients with IHD in the first place those who have had myocardial infarction and brain stroke with the aim of detection of depression and anxiety depressive symptoms and subsequent their adequate correction.
COORDINATA - Russian multicenter prospective (3 year long) study having the aim to elucidate influence of symptoms of anxiety and depression on cardiovascular (CV) prognosis in patients with arterial hypertension (AH) and ischemic heart disease (IHD). Results of 1.5 years of prospective phase of the study are presented. Material and methods. Symptoms of depression and anxiety were assessed by Hospital Anxiety and Depression Scale (HDS) in 5038 patients with AH and/or IHD aged 55 years and older. By the end of 1.5 years follow up telephonic interview was carried out with 4449 patients or their relatives in the course of which occurrence of soft and hard end points (cardiovascular complications and deaths of IHD, cardiovascular and other causes) were established. There were 142 deaths (60.6% cardiovascular), 85 strokes, and 42 dynamic disturbances of cerebral circulation. Total number of hard and soft end points was 356 (8.0%). Presence of depressive, anxious, and combined anxious-depressive symptoms in patients with AH/IHD at initial examination increased 1.5 - 2 fold risk of development of cardiovascular catastrophes and death (due to IHD, CV and all causes). Besides psychological factors clear-cut influence on prognosis exerted sex, age, level of education and income of patients, smoking (both in the past and at inclusion in the study), low level of daily physical activity, elevated levels of blood pressure and heart rate, as well as a row of social characteristics of patients.