Prevalence and types of anxiety disorders among patients with cardiac conditions and elevated HADS-A scores: findings from the initial screening phase of the Heart and Mind trial in Denmark

Clinical Snapshot

Key Findings

• P Value: Not reported for primary outcome

• Effect Size: Positive predictive value of 84% for HADS-A screening

• Primary Outcome: 84% of patients with HADS-A ≥8 met SCID criteria for anxiety disorder

• Nnt Or Sensitivity: Sensitivity cannot be calculated without false negative data

• Confidence Interval: Not reported

Clinical Application

HADS-A is brief, validated, and easily implemented in routine cardiac care Relevant to Australian cardiology practice; HADS widely used; supports RACGP guidelines on mental health screening in chronic disease Patients with cardiac conditions (arrhythmia, heart failure, ischaemic heart disease) in cardiology and primary care settings

Abstract

OBJECTIVES: To identify whether patients with arrhythmia, heart failure or ischaemic heart disease presenting with anxiety symptoms measured by the Hospital Anxiety and Depression Scale (HADS) have identifiable anxiety according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) and, if so, which type of anxiety disorder based on the SCID. DESIGN: Initial screening data from the Heart and Mind randomised clinical trial. SETTING: Patients with arrhythmia, heart failure or ischaemic heart disease were screened using HADS, and patients with a HADS-anxiety (HADS-A) score≥8 were invited to participate. Participants were interviewed by trained cardiac nurses using the SCID to determine whether they met the criteria for anxiety and, if so, the type of anxiety disorder. RESULTS: Of the 7816 patients who completed the HADS questionnaire, 1803 (23%) had a HADS-A score≥8. Among these, 398 (22%) agreed to the SCID interview, and 336 (84%) met the diagnostic criteria for an anxiety disorder. The mean age was 61 years, with 40% being female. The mean HADS-A score was 11.3 (SD=2.7). The most common types of anxiety were generalised anxiety disorder (61%), panic disorder (23%) and specific phobia (8%). CONCLUSIONS: The majority of individuals identified by the instrument also met the diagnostic criteria for an anxiety disorder. Generalised anxiety disorder and panic disorder were the most prevalent subtypes. Anxiety was common across the cardiac population, underscoring the need for routine assessment and targeted intervention in clinical practice. TRIAL REGISTRATION NUMBER: NCT04582734.

References

1. 1.Berg, S. K., Rasmussen, L. R., Thorup, C. B., Rasmussen, T. B., Christensen, A. V., Hammer, C. B., Jorgensen, M. B., Svendsen, J. H., Risom, S. S., Juul, C., & Schjødt, I. (2026). Prevalence and types of anxiety disorders among patients with cardiac conditions and elevated HADS-A scores: findings from the initial screening phase of the Heart and Mind trial in Denmark. BMJ Open. https://doi.org/10.1136/bmjopen-2025-113682